Provider Demographics
NPI:1225384878
Name:RILEY, KRISTIN L (PA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:RILEY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1600 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3019
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:866-264-8519
Practice Address - Street 1:615 E ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-7126
Practice Address - Country:US
Practice Address - Phone:813-719-2500
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106550363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant