Healthcare Provider Details

I. General information

NPI: 1639001167
Provider Name (Legal Business Name): KINTSUGI CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10120 S EASTERN AVE STE 130
HENDERSON NV
89052-3953
US

IV. Provider business mailing address

2820 ARAGON TERRACE WAY
HENDERSON NV
89044-1686
US

V. Phone/Fax

Practice location:
  • Phone: 775-269-2626
  • Fax: 702-940-4063
Mailing address:
  • Phone: 775-269-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGELA PALAKANIS
Title or Position: OWNER
Credential: APRN
Phone: 775-269-2626