MEDICARE: PELICAN PSYCHIATRY 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1952041675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELICAN PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	8755 DON HORTON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-7236
Country	:	US
Telephone Number	:	775-990-9364
Fax Number	:

Provider Business Practice Location Address
First Line	:	8755 DON HORTON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-7236
Country	:	US
Telephone Number	:	775-990-9364
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TROY PERKINS
Credential	:	APRN
Telephone Number	:	775-990-9364

Provider Enumeration Date	:	03/30/2022
Last Update Date	:	03/30/2022

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