Healthcare Provider Details

I. General information

NPI: 1306481031
Provider Name (Legal Business Name): BETHANY A BAIRD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 S EASTERN AVE STE 108
HENDERSON NV
89052-3908
US

IV. Provider business mailing address

400 N STEPHANIE ST STE 300
HENDERSON NV
89014-6692
US

V. Phone/Fax

Practice location:
  • Phone: 702-952-3444
  • Fax: 702-952-3494
Mailing address:
  • Phone: 702-952-3350
  • Fax: 702-952-3364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number826003
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number826003
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: