Individual ProviderJuan Carlos RivasNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address439 N Mclean Blvd Ste 204, Wichita, KS 67203-5900(316) 358-0025PECOS EnrollmentBased on the most recent information from CMS, provider Juan Carlos Rivas does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1417517996Provider TypeIndividualFull NameRivas, Juan CarlosCredentialAPRNGenderMaleSole ProprietorNoEnumeration Date6/18/2019Last Updated2/14/2023Contact InformationPractice LocationPractice Address439 N Mclean Blvd Ste 204, Wichita, KS 67203-5900Phone(316) 358-0025Fax(316) 776-4554Mailing LocationMailing Address439 N Mclean Blvd Ste 204, Wichita, KS 67203-5900Phone(316) 358-0025Fax(316) 776-4554Provider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense80189KansasCode363L00000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense112763Nebraska