Healthcare Provider Details

I. General information

NPI: 1275459042
Provider Name (Legal Business Name): MYKELL ERIN RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 COLD CREEK WAY
LAYTON UT
84041-7591
US

IV. Provider business mailing address

945 COLD CREEK WAY
LAYTON UT
84041-7591
US

V. Phone/Fax

Practice location:
  • Phone: 801-682-5898
  • Fax:
Mailing address:
  • Phone: 801-682-5898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0123456
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: