Healthcare Provider Details

I. General information

NPI: 1023625688
Provider Name (Legal Business Name): JERRI L BRACEY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N BUFFALO DR
LAS VEGAS NV
89128-0379
US

IV. Provider business mailing address

911 N BUFFALO DR UNIT 206
LAS VEGAS NV
89128-0381
US

V. Phone/Fax

Practice location:
  • Phone: 702-405-8088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number845035
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN68945
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: