MEDICARE: MRS. RAICHELLE ANDERSON

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	842119	NV

General Provider Information

NPI Number	:	1902779473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RAICHELLE ANDERSON

Provider Business Mailing Address
First Line	:	3311 S RAINBOW BLVD STE 108
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6596
Country	:	US
Telephone Number	:	702-703-5597
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 S RAINBOW BLVD STE 108
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6596
Country	:	US
Telephone Number	:	855-468-2343
Fax Number	:

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

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	12/03/2025

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