| Doctor Name: | LAKETA D RILEY |
| NPI Number: | 1003208729 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | 19326 |
| Business Practice Address: | 338 E Columbia Ave Suite B Batesburg-leesville, SC - 290709285 |
| Business Phone Number: | 8035321580 |
| Business Fax Number: | 8035323832 |
| Mailing Address: | Po Box 3788, COLUMBIA |
| State: | SC |
| Postal Code: | 292303788 |
| Phone Number: | 8037335969 |
| Fax Number: | 8037535591 |
| NPI Enumeration Date: | 03/04/2015 |
| NPI Last Update Date: | 06/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 19326 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |