Healthcare Provider Details

I. General information

NPI: 1326622788
Provider Name (Legal Business Name): PEACHES DUON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 W CHARLESTON BLVD STE 180
LAS VEGAS NV
89102-1903
US

IV. Provider business mailing address

2915 W CHARLESTON BLVD STE 180
LAS VEGAS NV
89102-1903
US

V. Phone/Fax

Practice location:
  • Phone: 702-258-4469
  • Fax: 702-259-0239
Mailing address:
  • Phone: 702-258-4469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number841040
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8141040
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: