Healthcare Provider Details

I. General information

NPI: 1871124388
Provider Name (Legal Business Name): KARA RIVERS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W MCCREIGHT AVE STE 110
SPRINGFIELD OH
45504-1890
US

IV. Provider business mailing address

100 W MCCREIGHT AVE STE 110
SPRINGFIELD OH
45504-1890
US

V. Phone/Fax

Practice location:
  • Phone: 937-523-9940
  • Fax: 937-523-9935
Mailing address:
  • Phone: 937-523-9940
  • Fax: 937-523-9935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.025067
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.025067
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: