Healthcare Provider Details

I. General information

NPI: 1922919364
Provider Name (Legal Business Name): ADOLPH PATTON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 CORPORATE CIR STE 120
HENDERSON NV
89074-7756
US

IV. Provider business mailing address

6755 W ARBY AVE APT 358
LAS VEGAS NV
89118-4764
US

V. Phone/Fax

Practice location:
  • Phone: 702-961-0033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number875595
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: