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NPI Code Detail

MEDICARE: MISS TERRA MICHELLE RILEY MS PAC

MEDICARE: MISS TERRA MICHELLE RILEY MS PAC
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
1363A00000XPhysician AssistantPA 19901CA
2363AM0700XMedical Physician AssistantPA04400TX
3363A00000XPhysician AssistantPA04400TX

General Provider Information

NPI Number : 1346271285
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS TERRA MICHELLE RILEY MS PAC
Provider Business Mailing Address
First Line : 9835 N LAKE CREEK PKWY
Second Line :
City : AUSTIN
State : TX
Zip : 78717-6210
Country : US
Telephone Number : 832-824-1000
Fax Number :
Provider Business Practice Location Address
First Line : 9835 N LAKE CREEK PKWY
Second Line :
City : AUSTIN
State : TX
Zip : 78717-6210
Country : US
Telephone Number : 310-594-3675
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 10/26/2023

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Directions to “ MISS TERRA MICHELLE RILEY MS PAC” Practice Location

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