Provider Demographics
NPI:1871214916
Name:RILEY, VICTORIA RUTH MCCALL
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:RUTH MCCALL
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 HAWKINS ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2019
Mailing Address - Country:US
Mailing Address - Phone:580-490-2118
Mailing Address - Fax:
Practice Address - Street 1:15 MONROE ST NE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2025
Practice Address - Country:US
Practice Address - Phone:580-226-1838
Practice Address - Fax:580-223-7856
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program