Individual
MRS. REBECCA RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7725 HIGHWAY 62 STE 100, CHARLESTOWN, IN 47111
(812) 280-0413
(812) 280-0465
Mailing address
2700 STANLEY GAULT PKWY STE 129, LOUISVILLE, KY 40223-5176
(502) 253-4917
(502) 487-5751
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001839A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300007796
—
IN
01
—
IN1189154
IN MEDICARE
IN
01
—
PA08679
TEXAS MEDICAL BOARD PA LICENSE NUMBER
TX
Enumeration date
11/07/2013
Last updated
05/23/2018
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