Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 6907 | LA |
Y | 213EG0000X | General Practice | 6907 | LA |
NPI | 1003354929 |
---|---|
Provider Name | Jamila Mckinnis Riley |
First Address | Franklin, LA 70538-4124 |
Second Address | Franklin, LA 70538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2017 |
Last Update Date | 22/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2485130 | (05) | LA |