Provider Demographics
NPI:1366932543
Name:RILEY, ANGELA DEANISE (FNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DEANISE
Last Name:RILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DEANISE
Other - Last Name:PRUITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2302 N MISSION CIR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5993
Mailing Address - Country:US
Mailing Address - Phone:832-723-8521
Mailing Address - Fax:
Practice Address - Street 1:3043 GESSNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-1000
Practice Address - Country:US
Practice Address - Phone:713-939-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine