MEDICARE: TEAIRRA MARIE PRENTICE

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	89833	NV

General Provider Information

NPI Number	:	1922959030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEAIRRA MARIE PRENTICE

Provider Business Mailing Address
First Line	:	2110 E FLAMINGO RD STE 309
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5193
Country	:	US
Telephone Number	:	951-536-1028
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5190
Country	:	US
Telephone Number	:	725-331-1100
Fax Number	:

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

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/13/2026

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Directions to “ TEAIRRA MARIE PRENTICE ” Practice Location

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