Provider Demographics
NPI:1316575707
Name:RIVERS, MELISSA FAY (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:FAY
Last Name:RIVERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 CARLA DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-5734
Mailing Address - Country:US
Mailing Address - Phone:214-287-9406
Mailing Address - Fax:
Practice Address - Street 1:3218 CARLA DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-5734
Practice Address - Country:US
Practice Address - Phone:214-287-9406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX986295163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse