Provider Demographics
NPI:1790176832
Name:RIVERS PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:RIVERS PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:318-419-3592
Mailing Address - Street 1:5920 COLISEUM BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3714
Mailing Address - Country:US
Mailing Address - Phone:318-443-9339
Mailing Address - Fax:318-443-9116
Practice Address - Street 1:5920 COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3714
Practice Address - Country:US
Practice Address - Phone:318-443-9339
Practice Address - Fax:318-443-9116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08178363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty