Healthcare Provider Details

I. General information

NPI: 1649909102
Provider Name (Legal Business Name): ALYSSA NICOLE HILDT MOXLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 07/09/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 ROSE ST
LAS VEGAS NV
89106-4020
US

IV. Provider business mailing address

8906 SPANISH RIDGE AVE STE 202
LAS VEGAS NV
89148-1319
US

V. Phone/Fax

Practice location:
  • Phone: 702-438-4692
  • Fax: 702-485-2372
Mailing address:
  • Phone: 702-330-3102
  • Fax: 702-912-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number11770631-3102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number875147
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95326282
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number875147
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW236376
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95027659
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number875147
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: