Healthcare Provider Details

I. General information

NPI: 1780309757
Provider Name (Legal Business Name): RIVERSTONE WELLNESS, NP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 SIERRA DR
KERNVILLE CA
93238-1006
US

IV. Provider business mailing address

PO BOX 363
WOFFORD HEIGHTS CA
93285-0363
US

V. Phone/Fax

Practice location:
  • Phone: 760-417-2392
  • Fax: 760-376-3034
Mailing address:
  • Phone: 760-417-2392
  • Fax: 760-376-3034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HEATHER SANDRA BERRY
Title or Position: NP FOUNDER CLINICAL DIRECTOR
Credential: LCSW
Phone: 760-417-2392