MEDICARE: XARENY RIVERA PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	839835	NV

General Provider Information

NPI Number	:	1760213466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XARENY RIVERA PMHNP-BC

Provider Business Mailing Address
First Line	:	466 SEARCHLIGHT DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3806
Country	:	US
Telephone Number	:	702-622-9721
Fax Number	:

Provider Business Practice Location Address
First Line	:	2881 S VALLEY VIEW BLVD STE 4
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-0170
Country	:	US
Telephone Number	:	702-852-6633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2024
Last Update Date	:	08/13/2024

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