Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 19326 | SC |
N | 363L00000X | Nurse Practitioner | RN288707 | GA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 19326 | SC |
NPI | 1003208729 |
---|---|
Provider Name | Laketa D Riley |
First Address | West Columbia, SC 29169 |
Second Address | West Columbia, SC 29169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2015 |
Last Update Date | 12/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP3207 | (05) | SC |