Healthcare Provider Details

I. General information

NPI: 1851415301
Provider Name (Legal Business Name): KRISTA MARIE RIVERA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SIX PINE RANCH RD
BATESVILLE IN
47006-1399
US

IV. Provider business mailing address

PO BOX 236
BATESVILLE IN
47006-0236
US

V. Phone/Fax

Practice location:
  • Phone: 812-933-3728
  • Fax: 812-933-3729
Mailing address:
  • Phone: 812-933-3828
  • Fax: 812-933-3729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004432A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: