Healthcare Provider Details

I. General information

NPI: 1396289831
Provider Name (Legal Business Name): ALLIE MACADAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLIE MORIARTY

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 E. BRUNER AVE STE 130
HENDERSON NV
89044
US

IV. Provider business mailing address

475 E. BRUNER AVE STE 130
HENDERSON NV
89044
US

V. Phone/Fax

Practice location:
  • Phone: 702-763-2263
  • Fax: 702-723-3765
Mailing address:
  • Phone: 702-763-2263
  • Fax: 702-723-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPA0785
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: