Provider Demographics
NPI:1043966120
Name:RILEY, HEATHER (CPNP-PC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 W NORTHVIEW LOOP
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3012
Mailing Address - Country:US
Mailing Address - Phone:406-250-1778
Mailing Address - Fax:
Practice Address - Street 1:1273 BURNS WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3109
Practice Address - Country:US
Practice Address - Phone:406-752-8300
Practice Address - Fax:406-752-3542
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-27
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-192813363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics