Provider Demographics
NPI:1407425846
Name:KIMBERLY A RIVERA
Entity Type:Organization
Organization Name:KIMBERLY A RIVERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:985-640-1043
Mailing Address - Street 1:5032 HOUSE SPARROW DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3032
Mailing Address - Country:US
Mailing Address - Phone:985-640-1043
Mailing Address - Fax:
Practice Address - Street 1:126 PONTCHARTRAIN OAKS DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-9642
Practice Address - Country:US
Practice Address - Phone:985-974-1149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty