MEDICARE: MRS. SARAH ANN RILEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	20076	SC

General Provider Information

NPI Number	:	1295199859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH ANN RILEY

Provider Business Mailing Address
First Line	:	2740 RINGGOLD RD
Second Line	:
City	:	FORT SILL
State	:	OK
Zip	:	73503-4449
Country	:	US
Telephone Number	:	803-602-4003
Fax Number	:	580-558-3200

Provider Business Practice Location Address
First Line	:	2740 RINGGOLD RD
Second Line	:
City	:	FORT SILL
State	:	OK
Zip	:	73503-4449
Country	:	US
Telephone Number	:	803-602-4003
Fax Number	:	580-558-3200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2016
Last Update Date	:	06/10/2025

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