Provider Demographics
NPI:1700164753
Name:RIVERS, SCOTT ALEXANDER (NP)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALEXANDER
Last Name:RIVERS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:G
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:13409 CRANE CANYON LOOP
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7221
Mailing Address - Country:US
Mailing Address - Phone:719-440-8859
Mailing Address - Fax:
Practice Address - Street 1:1259 LAKE PLAZA DR STE 260
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3560
Practice Address - Country:US
Practice Address - Phone:719-418-6418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0991621-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner