Healthcare Provider Details

I. General information

NPI: 1316879968
Provider Name (Legal Business Name): RACHEL WYSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 N TOWN CENTER DR
LAS VEGAS NV
89144-6367
US

IV. Provider business mailing address

6188 WINDFRESH DR
LAS VEGAS NV
89148-4704
US

V. Phone/Fax

Practice location:
  • Phone: 702-233-7000
  • Fax:
Mailing address:
  • Phone: 702-576-1971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3462
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: