Basic Information
| Provider Information | |||||||||
| NPI: | 1851716955 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVERO | ||||||||
| FirstName: | RACHAEL | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3009 N. CYPRESS | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672264003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3164401010 | ||||||||
| FaxNumber: | 3164400802 | ||||||||
| Practice Location | |||||||||
| Address1: | 3009 N. CYPRESS | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672264003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3164401010 | ||||||||
| FaxNumber: | 3164400802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2014 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 76244 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 200528280A | 05 | OK | MEDICAID | 201092330A | 05 | KS | MEDICAID |