Healthcare Provider Details

I. General information

NPI: 1336835404
Provider Name (Legal Business Name): FULL CIRCLE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/20/2024
Certification Date: 04/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 E FLAMINGO RD STE 105
LAS VEGAS NV
89119-5191
US

IV. Provider business mailing address

2110 E FLAMINGO RD STE 105
LAS VEGAS NV
89119-5191
US

V. Phone/Fax

Practice location:
  • Phone: 702-695-2084
  • Fax: 702-537-0981
Mailing address:
  • Phone: 702-695-2084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JENNIFER ELIZABETH STORY-SALACUP
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 702-513-5533