Provider Demographics
NPI:1689459448
Name:RILEY, JERICA LYNN (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JERICA
Middle Name:LYNN
Last Name:RILEY
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3716 VALLEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:KY
Mailing Address - Zip Code:40055-9706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:231 MIDLAND PARK
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-9735
Practice Address - Country:US
Practice Address - Phone:502-633-6411
Practice Address - Fax:502-633-6657
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY1148887163WP2201X
KY4040060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care