Mary Kathryn Riley, RN, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

30228 Issued in TN

Practice address

1022 Greystone SQ
Jackson, TN 38305-3580

Phone

(731) 300-2001

Fax

(731) 240-8095

NPI assigned

Aug 2, 2021

Last updated

Sep 3, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Arthritis Clinic, PLLC

  • Specialist
  • Jackson, TN
  • NPI 1144499757
  Medicare reassignment NPD
• Family Medical Clinic of Trezevant

  • Primary Care Clinic/Center
  • Jackson, TN
  • NPI 1215693171
  NPD
• Family Medical Clinic of Trezevant

  • Rural Health Clinic/Center
  • Trezevant, TN
  • NPI 1538703897
  NPD (past)

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

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1861166191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "371 N PARKWAY STE 400",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052891",
            "telephone_number": "731-664-0002",
            "fax_number": "731-664-7859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1022 GREYSTONE SQ",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053580",
            "telephone_number": "731-300-2001",
            "fax_number": "731-240-8095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RILEY",
        "first_name": "MARY",
        "middle_name": "KATHRYN",
        "credential": "RN, FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-02",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "30228",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "188898",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelli Denise Riggs, M.A. CCC SLP
• Claire E Rikard, M.D.
• Cody Riley, PTA
• Cory Riley, DNP-CRNA
• Elly K Riley, DO
• Retta Riley
• Jacqueline Risley, PHARMD
• Riverside Medical Inc (Quipt Home Medical)
• Renee Roark, LPC/MHSP
• Stephanie Robb

• Nurse Practitioner in Jackson, TN
• Providers in Jackson, TN by specialty
• Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.