Healthcare Provider Details

I. General information

NPI: 1265248736
Provider Name (Legal Business Name): RES WOUND CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 S RAINBOW BLVD STE 5
LAS VEGAS NV
89118-4209
US

IV. Provider business mailing address

5920 S RAINBOW BLVD STE 5
LAS VEGAS NV
89118-4209
US

V. Phone/Fax

Practice location:
  • Phone: 725-724-6376
  • Fax: 702-446-6500
Mailing address:
  • Phone: 725-724-6376
  • Fax: 702-446-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SPARKLE SIMPSON
Title or Position: OWNER
Credential:
Phone: 702-202-7801