Healthcare Provider Details

I. General information

NPI: 1194389569
Provider Name (Legal Business Name): AMON DENZEL LESTER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 07/13/2024
Certification Date: 07/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 CORONADO CENTER DR STE 220
HENDERSON NV
89052-3992
US

IV. Provider business mailing address

861 CORONADO CENTER DR STE 220
HENDERSON NV
89052-3992
US

V. Phone/Fax

Practice location:
  • Phone: 702-933-1485
  • Fax:
Mailing address:
  • Phone: 702-933-1485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number820033
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number820033
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: