Provider Demographics
NPI:1801508775
Name:RIVERA, ALEXIS JEAN (APRN)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JEAN
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 1:61 CHINQUEPIN DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-4505
Mailing Address - Country:US
Mailing Address - Phone:870-949-7389
Mailing Address - Fax:
Practice Address - Street 1:403 W OAK ST STE 301
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4575
Practice Address - Country:US
Practice Address - Phone:870-862-8221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR220943363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics