Individual
KELLY LAROSE RIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3 RICHLAND MEDICAL PARK DR STE 100, COLUMBIA, SC 29203-6850
(803) 736-3277
Mailing address
15 EXCHANGE DR, LUGOFF, SC 29078-9198
(803) 736-3277
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4543
SC
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
01/15/2021
Last updated
03/27/2026
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