Healthcare Provider Details

I. General information

NPI: 1770152175
Provider Name (Legal Business Name): KIMBERLY AROMY RIVERA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date: 06/29/2021
Reactivation Date: 09/30/2021

III. Provider practice location address

835 PRIDE DR STE B
HAMMOND LA
70401-9527
US

IV. Provider business mailing address

5032 HOUSE SPARROW DR
MADISONVILLE LA
70447-3032
US

V. Phone/Fax

Practice location:
  • Phone: 985-543-4333
  • Fax:
Mailing address:
  • Phone: 985-640-1043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220156
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: