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Individual

MS. MATTIE ANN RILEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
6351 BROWN HOOKE RD, MERIDIAN, MS 39305-8994
(601) 737-5121
Mailing address
5322 CHANDLER RD, MERIDIAN, MS 39305-9750
(601) 483-0046

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P118958
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00770132
MS
Enumeration date
05/10/2007
Last updated
07/08/2007
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