Healthcare Provider Details

I. General information

NPI: 1912898701
Provider Name (Legal Business Name): SALTY LIGHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 E LAKE MEAD PKWY STE 130
HENDERSON NV
89015-4647
US

IV. Provider business mailing address

1477 E LAKE MEAD PKWY STE 130
HENDERSON NV
89015-4647
US

V. Phone/Fax

Practice location:
  • Phone: 725-726-2364
  • Fax:
Mailing address:
  • Phone: 725-726-2364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATHER CLAWSON
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 725-726-2364