MEDICARE: RILEY KAE OBERHOLTZER

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	363LG0600X	Gerontology Nurse Practitioner	238479	AZ
2	363LA2100X	Acute Care Nurse Practitioner	238479	AZ
3	363LA2200X	Adult Health Nurse Practitioner	238479	AZ

General Provider Information

NPI Number	:	1952185076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEY KAE OBERHOLTZER

Provider Business Mailing Address
First Line	:	9225 N 3RD ST STE 300
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2466
Country	:	US
Telephone Number	:	602-445-0751
Fax Number	:	602-424-8128

Provider Business Practice Location Address
First Line	:	9225 N 3RD ST STE 300
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2466
Country	:	US
Telephone Number	:	602-445-0751
Fax Number	:

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

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	01/16/2026

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Directions to “ RILEY KAE OBERHOLTZER ” Practice Location

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