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NPI Code Detail

MEDICARE: ANTOINETTE R RILEY FNP, DCNP

MEDICARE: ANTOINETTE R RILEY FNP, DCNP
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
1174400000XSpecialist
2363LF0000XFamily Nurse Practitioner630914TX

General Provider Information

NPI Number : 1659302545
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTOINETTE R RILEY FNP, DCNP
Provider Business Mailing Address
First Line : PO BOX 1326
Second Line :
City : MARSHALL
State : TX
Zip : 75671-1326
Country : US
Telephone Number : 903-927-3782
Fax Number : 903-927-1764
Provider Business Practice Location Address
First Line : 1011 S WILLIAM ST
Second Line :
City : ATLANTA
State : TX
Zip : 75551-3245
Country : US
Telephone Number : 903-796-2868
Fax Number : 903-796-0826
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 06/13/2024

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