Provider Demographics
NPI:1740910280
Name:RIVERO, KATHRYNE LAURALEE (RN, ARPN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:KATHRYNE
Middle Name:LAURALEE
Last Name:RIVERO
Suffix:
Gender:
Credentials:RN, ARPN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 DELORES DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4851
Mailing Address - Country:US
Mailing Address - Phone:972-657-0984
Mailing Address - Fax:
Practice Address - Street 1:1759 BROAD PARK CIR S STE 201
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7834
Practice Address - Country:US
Practice Address - Phone:682-341-3910
Practice Address - Fax:682-400-1288
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1084533363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics