Provider Demographics
NPI:1013796614
Name:RIVERA, JESSICA (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1106 W PARK ST
Mailing Address - Street 2:SUITE 20 PMB 428
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2955
Mailing Address - Country:US
Mailing Address - Phone:602-791-3411
Mailing Address - Fax:602-297-6964
Practice Address - Street 1:676 S FERGUSON AVE STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-1951
Practice Address - Country:US
Practice Address - Phone:602-791-3411
Practice Address - Fax:602-297-6964
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2025-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP61539312363LP0808X
AZ298068363LP0808X
MTAPRN-239192363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health