Provider Demographics
NPI:1366157992
Name:RIVERA, ALEXA (FNP-C)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 SELWYN FARMS LN APT 3
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-4073
Mailing Address - Country:US
Mailing Address - Phone:901-413-2252
Mailing Address - Fax:
Practice Address - Street 1:9705 NORTHEAST PKWY STE 400
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-9704
Practice Address - Country:US
Practice Address - Phone:704-844-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily