Healthcare Provider Details

I. General information

NPI: 1235906330
Provider Name (Legal Business Name): HENDERSON PSYCHIATRY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 WIGWAM PKWY STE 100
HENDERSON NV
89074-8178
US

IV. Provider business mailing address

9490 STONE CASTLE WAY
LAS VEGAS NV
89123-5904
US

V. Phone/Fax

Practice location:
  • Phone: 702-454-0201
  • Fax:
Mailing address:
  • Phone: 702-883-0349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANSY JOHN
Title or Position: CEO
Credential: NP
Phone: 702-454-0201