Provider Demographics
NPI:1033695267
Name:RISLEY, EMILY CATHERINE (FNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CATHERINE
Last Name:RISLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3409
Mailing Address - Country:US
Mailing Address - Phone:307-578-2486
Mailing Address - Fax:
Practice Address - Street 1:424 YELLOWSTONE AVE STE 230
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9310
Practice Address - Country:US
Practice Address - Phone:307-578-2975
Practice Address - Fax:307-578-2979
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY32248.1768363LF0000X
WY1768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY150166600Medicaid