Healthcare Provider Details

I. General information

NPI: 1114393568
Provider Name (Legal Business Name): MCGINNIS MICA MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 W ELLIOTT AVE # 300
BEATTY NV
89003-0300
US

IV. Provider business mailing address

PO BOX 300
BEATTY NV
89003-0300
US

V. Phone/Fax

Practice location:
  • Phone: 702-706-4362
  • Fax: 877-991-6606
Mailing address:
  • Phone: 702-706-4362
  • Fax: 877-991-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN001078
License Number StateNV

VIII. Authorized Official

Name: DR. DIANE M MCGINNIS
Title or Position: PRESIDENT
Credential: DNP, APRN, FNP-C
Phone: 702-706-4362