Provider Demographics
NPI:1730732249
Name:RILEY, CALLIE SHAREE (FNP)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:SHAREE
Last Name:RILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:SHAREE
Other - Last Name:RANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 DONLEY DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-2612
Mailing Address - Country:US
Mailing Address - Phone:325-280-5518
Mailing Address - Fax:940-591-7802
Practice Address - Street 1:323 N BONNIE BRAE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3727
Practice Address - Country:US
Practice Address - Phone:940-484-7100
Practice Address - Fax:940-484-7101
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996888-NP363L00000X
CORXN.0105913-NP363L00000X
TXAP142198363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000198496Medicaid