Provider Demographics
NPI:1689084154
Name:RILEY, CAYLEY MARANDA (QBHP)
Entity type:Individual
Prefix:
First Name:CAYLEY
Middle Name:MARANDA
Last Name:RILEY
Suffix:
Gender:F
Credentials:QBHP
Other - Prefix:
Other - First Name:CAYLEY
Other - Middle Name:MARANDA
Other - Last Name:STAFFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:QBHP
Mailing Address - Street 1:1815 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-7870
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-361-3393
Practice Address - Street 1:2126 N 1ST ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-2870
Practice Address - Country:US
Practice Address - Phone:501-982-5000
Practice Address - Fax:501-982-5007
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator