Provider Demographics
NPI:1851415301
Name:RIVERA, KRISTA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:RIVERA
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-0236
Mailing Address - Country:US
Mailing Address - Phone:812-933-3828
Mailing Address - Fax:812-933-3729
Practice Address - Street 1:24 SIX PINE RANCH RD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-1399
Practice Address - Country:US
Practice Address - Phone:812-933-3728
Practice Address - Fax:812-933-3729
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10004432A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant