Healthcare Provider Details

I. General information

NPI: 1770199341
Provider Name (Legal Business Name): NICOLE KASSANDRA CARISSIMI MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE MINIUM

II. Dates (important events)

Enumeration Date: 09/19/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 S 6TH ST STE N
LAS VEGAS NV
89101-6928
US

IV. Provider business mailing address

732 S 6TH ST STE N
LAS VEGAS NV
89101-6928
US

V. Phone/Fax

Practice location:
  • Phone: 702-518-2707
  • Fax: 616-226-4668
Mailing address:
  • Phone: 702-518-2707
  • Fax: 616-226-4668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number890790
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: