Healthcare Provider Details

I. General information

NPI: 1174489686
Provider Name (Legal Business Name): KRISTEN DANIELLE RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 PASEO DEL PUEBLO SUR STE 140
TAOS NM
87571-7002
US

IV. Provider business mailing address

920 CAMINO DE LA SERNA
TAOS NM
87571-4367
US

V. Phone/Fax

Practice location:
  • Phone: 575-201-3325
  • Fax:
Mailing address:
  • Phone: 505-573-3669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number1003257924
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: