Healthcare Provider Details

I. General information

NPI: 1194017624
Provider Name (Legal Business Name): AMY LOUISE HAYCRAFT N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9012 ECHO RIDGE DR
LAS VEGAS NV
89117-5437
US

IV. Provider business mailing address

9012 ECHO RIDGE DR
LAS VEGAS NV
89117-5437
US

V. Phone/Fax

Practice location:
  • Phone: 480-206-9477
  • Fax: 949-991-4208
Mailing address:
  • Phone: 480-206-9477
  • Fax: 949-991-4208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP3999
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95027546
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number608
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number890455
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: