Provider Demographics
NPI:1770247355
Name:RIVERA, JESSICA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42702-0340
Mailing Address - Country:US
Mailing Address - Phone:270-506-2730
Mailing Address - Fax:
Practice Address - Street 1:2000 RING RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9454
Practice Address - Country:US
Practice Address - Phone:502-694-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1141654163WM0102X
KY3018599363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn