Healthcare Provider Details

I. General information

NPI: 1114881844
Provider Name (Legal Business Name): NOHEMY RIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ROGERS AVE STE 24
FORT SMITH AR
72903-3152
US

IV. Provider business mailing address

4300 ROGERS AVE STE 24
FORT SMITH AR
72903-3152
US

V. Phone/Fax

Practice location:
  • Phone: 501-269-1656
  • Fax: 501-325-1255
Mailing address:
  • Phone: 501-269-1656
  • Fax: 501-325-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: