Healthcare Provider Details

I. General information

NPI: 1487335238
Provider Name (Legal Business Name): RILEY A WATSON PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N TENAYA WAY STE 320
LAS VEGAS NV
89128-0447
US

IV. Provider business mailing address

PO BOX 100744
ATLANTA GA
30384-0744
US

V. Phone/Fax

Practice location:
  • Phone: 702-962-2100
  • Fax: 702-962-5620
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3276
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: