Individual
MRS. ATALIE IRENE RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 593-8441
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9104226
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
284523201
—
TX
05
—
284523202
—
TX
01
—
75-2616977-042
TRICARE
TX
01
—
854N58
BCBS
TX
Enumeration date
08/22/2007
Last updated
10/24/2014
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