Healthcare Provider Details

I. General information

NPI: 1629758131
Provider Name (Legal Business Name): RENEWING HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6916 CEDAR BASIN AVE
LAS VEGAS NV
89142-3719
US

IV. Provider business mailing address

6916 CEDAR BASIN AVE
LAS VEGAS NV
89142-3719
US

V. Phone/Fax

Practice location:
  • Phone: 725-296-2496
  • Fax: 801-845-9782
Mailing address:
  • Phone: 725-296-2496
  • Fax: 801-845-9782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KEESHA ANGELEA DAVIS
Title or Position: MANAGER
Credential: APRN,PMHNP-BC
Phone: 725-296-2496