MEDICARE: RILEY KLINE PA-C

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	363A00000X	Physician Assistant	2644	OK

General Provider Information

NPI Number	:	1306205158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEY KLINE PA-C

Provider Business Mailing Address
First Line	:	822 W RANDOLPH AVE
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-3834
Country	:	US
Telephone Number	:	580-599-0272
Fax Number	:	580-603-8602

Provider Business Practice Location Address
First Line	:	822 W RANDOLPH AVE
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-3834
Country	:	US
Telephone Number	:	580-599-0272
Fax Number	:	580-603-8602

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

Provider Enumeration Date	:	02/22/2016
Last Update Date	:	09/19/2021

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Directions to “ RILEY KLINE PA-C” Practice Location

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