Provider Demographics
NPI:1720228026
Name:RIVERS, KARON R (ARNP)
Entity Type:Individual
Prefix:
First Name:KARON
Middle Name:R
Last Name:RIVERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KARON
Other - Middle Name:
Other - Last Name:MICKLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJAX - COMMUNITY HEALTH CENTER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-5121
Practice Address - Fax:904-244-5965
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3081862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0008531-00Medicaid
GA651594411AMedicaid
FLBN317ZMedicare PIN
FLP01082104Medicare PIN