Provider Demographics
NPI:1144556663
Name:RILEY, KATHLEEN MEGAN (CNM)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MEGAN
Last Name:RILEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 EGG HARBOR RD
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2359
Mailing Address - Country:US
Mailing Address - Phone:856-218-0300
Mailing Address - Fax:856-589-9487
Practice Address - Street 1:570 EGG HARBOR RD
Practice Address - Street 2:SUITE C-2
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2359
Practice Address - Country:US
Practice Address - Phone:856-218-0300
Practice Address - Fax:856-589-9487
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH067625-23367A00000X
MECNM122007367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0221899Medicaid
NJ0221899Medicaid