Provider Demographics
NPI:1306401419
Name:RIVERS-FLEMING, QUATINA LASHA (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:QUATINA
Middle Name:LASHA
Last Name:RIVERS-FLEMING
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 IVY CHASE LOOP
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-0946
Mailing Address - Country:US
Mailing Address - Phone:815-450-7959
Mailing Address - Fax:
Practice Address - Street 1:522 IVY CHASE LOOP
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-0946
Practice Address - Country:US
Practice Address - Phone:815-450-7959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239384363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care