Provider Demographics
NPI:1083459614
Name:RILEY, KATHLEEN EMILIA (FNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:EMILIA
Last Name:RILEY
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-662-6000
Mailing Address - Fax:910-792-0160
Practice Address - Street 1:5145 COLLEGE RD S
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2207
Practice Address - Country:US
Practice Address - Phone:910-662-6000
Practice Address - Fax:910-550-3787
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC5020394363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program