Healthcare Provider Details

I. General information

NPI: 1023058005
Provider Name (Legal Business Name): ANGELA D RIVERO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3239 N WESTWIND BAY CT
WICHITA KS
67205-2525
US

IV. Provider business mailing address

3239 N WESTWIND BAY CT
WICHITA KS
67205-2525
US

V. Phone/Fax

Practice location:
  • Phone: 316-992-7900
  • Fax:
Mailing address:
  • Phone: 316-992-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44852
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number44853
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number44853
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: