MEDICARE: EMILY M RIVERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1023054	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215528807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY M RIVERA

Provider Business Mailing Address
First Line	:	3645 CRESTSIDE RD
Second Line	:
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-1564
Country	:	US
Telephone Number	:	214-546-3715
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 MEDICAL PARK DR E STE 453
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-3472
Country	:	US
Telephone Number	:	205-831-9783
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2021
Last Update Date	:	01/30/2026

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Directions to “ EMILY M RIVERA ” Practice Location

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