Healthcare Provider Details

I. General information

NPI: 1295658011
Provider Name (Legal Business Name): YANNIE BODDEN APRN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4592 CLAY PEAK DR
LAS VEGAS NV
89129-2217
US

IV. Provider business mailing address

4592 CLAY PEAK DR
LAS VEGAS NV
89129-2217
US

V. Phone/Fax

Practice location:
  • Phone: 469-915-4211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AL BERRY
Title or Position: MANAGER
Credential:
Phone: 469-915-4211