Provider Demographics
NPI:1053956383
Name:RILEY, JUDY R (LPN)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:R
Last Name:RILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 BLEWER RD
Mailing Address - Street 2:
Mailing Address - City:COPE
Mailing Address - State:SC
Mailing Address - Zip Code:29038-9330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1615 BLEWER RD
Practice Address - Street 2:
Practice Address - City:COPE
Practice Address - State:SC
Practice Address - Zip Code:29038-9330
Practice Address - Country:US
Practice Address - Phone:803-596-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC47649164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse