Individual
TARA RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5801 BREMO RD, RICHMOND, VA 23226-1907
(816) 820-8082
Mailing address
3016 PARK AVE APT A, RICHMOND, VA 23221-1608
(816) 820-8082
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110009094
VA
Other
Enumeration date
01/24/2023
Last updated
01/25/2023
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