Provider Demographics
NPI:1700164753
Name:RIVERS, SCOTT ALEXANDER (NP)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALEXANDER
Last Name:RIVERS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:G
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13256 CEDARVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7637
Mailing Address - Country:US
Mailing Address - Phone:719-434-1926
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:B7500
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4603
Practice Address - Country:US
Practice Address - Phone:719-524-4056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX710771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily