MEDICARE: MS. DEBORAH LINDSEY RIVERSTAR FNP-BC, RN

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	363LF0000X	Family Nurse Practitioner	637801	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8Y4035	OTHER	TX	BCBS PVN
2	4723	OTHER	TX	TSBNE NUMBER
3	NO139492	OTHER	TX	DPS

General Provider Information

NPI Number	:	1699712877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH LINDSEY RIVERSTAR FNP-BC, RN

Provider Business Mailing Address
First Line	:	8312 HANBRIDGE LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-3010
Country	:	US
Telephone Number	:	512-917-7333
Fax Number	:

Provider Business Practice Location Address
First Line	:	8312 HANBRIDGE LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-3010
Country	:	US
Telephone Number	:	512-917-7333
Fax Number	:

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	03/07/2023

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