Healthcare Provider Details

I. General information

NPI: 1922802875
Provider Name (Legal Business Name): ALLISON RAE MINK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2779 W HORIZON RIDGE PKWY STE 200
HENDERSON NV
89052-4186
US

IV. Provider business mailing address

1801 N GREEN VALLEY PKWY APT 724
HENDERSON NV
89074-5828
US

V. Phone/Fax

Practice location:
  • Phone: 702-990-2290
  • Fax: 702-990-2297
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: