MEDICARE: RES WOUND CARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1265248736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RES WOUND CARE PLLC

Provider Business Mailing Address
First Line	:	5920 S RAINBOW BLVD STE 5
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4209
Country	:	US
Telephone Number	:	725-724-6376
Fax Number	:	702-446-6500

Provider Business Practice Location Address
First Line	:	5920 S RAINBOW BLVD STE 5
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4209
Country	:	US
Telephone Number	:	725-724-6376
Fax Number	:	702-446-6500

Authorized Official
Title or Position	:	OWNER
Name	:	SPARKLE SIMPSON
Credential	:
Telephone Number	:	702-202-7801

Provider Enumeration Date	:	12/09/2024
Last Update Date	:	03/20/2026

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