Individual provider Active NPI

Emily Terese Riedy, RN, FNP

  • Family Nurse Practitioner
  • Novato, CA
National Provider Identifier
1124390224
Registry record updated Sep 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
21566 Issued in CA
Practice address
6100 Redwood Blvd
Novato, CA 94945-4501
Phone
(415) 448-1500
NPI assigned
Feb 3, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 766380 CA
Family Nurse Practitioner 363LF0000X 21566 CA Primary

Addresses

Primary practice location

6100 Redwood Blvd
Novato, CA 94945-4501

Mailing address

6100 Redwood Blvd
Novato, CA 94945-4501
Phone (415) 448-1500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150824001578 CA Order and Referring Only - Nurse Practitioner 3173839966

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
766380CAMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473033600000",
    "number": "1124390224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 REDWOOD BLVD",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949454501",
            "telephone_number": "415-448-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 REDWOOD BLVD",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949454501",
            "telephone_number": "415-448-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIEDY",
        "first_name": "EMILY",
        "middle_name": "TERESE",
        "name_prefix": "Miss",
        "credential": "RN, FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-03",
        "last_updated": "2016-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "766380",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "21566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Novato, CA

Sources for this page

Verify at the official NPI Registry.