MEDICARE: MALYSSA D HERNANDEZ APRN

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	853485	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	853485	OTHER	NV	APRN-CNP

General Provider Information

NPI Number	:	1417690165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALYSSA D HERNANDEZ APRN

Provider Business Mailing Address
First Line	:	9010 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8932
Country	:	US
Telephone Number	:	725-216-1762
Fax Number	:	702-240-0206

Provider Business Practice Location Address
First Line	:	2551 N GREEN VALLEY PKWY # 425A
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-0272
Country	:	US
Telephone Number	:	702-450-3385
Fax Number	:	702-898-1699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2022
Last Update Date	:	01/12/2026

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