Provider Demographics
NPI:1336149137
Name:RIVERA, DARLA K (DO)
Entity type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:K
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:7111 E 21ST STREET N
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206
Mailing Address - Country:US
Mailing Address - Phone:316-684-2851
Mailing Address - Fax:316-686-7338
Practice Address - Street 1:7111 E 21ST STREET N
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206
Practice Address - Country:US
Practice Address - Phone:316-684-2851
Practice Address - Fax:316-686-7338
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS05-22566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS101599OtherBLUE CROSS INDIVIDUAL
KS100231360BOtherMEDICAID INDIVIDUAL
KS100416440AMedicaid
KS80186349OtherRAILROAD MEDICARE
KS622091OtherFIRSTGUARD
KS110718OtherBLUE CROSS GROUP
KSE66472Medicare UPIN
KS110718OtherBLUE CROSS GROUP
IA110718Medicare ID - Type UnspecifiedGROUP