Healthcare Provider Details

I. General information

NPI: 1669179503
Provider Name (Legal Business Name): RILEY LAUREN VAN BEVERS CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4927 S COLLINS ST
ARLINGTON TX
76018-1160
US

IV. Provider business mailing address

4927 S COLLINS ST
ARLINGTON TX
76018-1160
US

V. Phone/Fax

Practice location:
  • Phone: 817-465-1171
  • Fax: 817-465-6044
Mailing address:
  • Phone: 817-465-1171
  • Fax: 817-465-6044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1110561
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: