Healthcare Provider Details

I. General information

NPI: 1821893868
Provider Name (Legal Business Name): 702 PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 W SAHARA AVE STE 106
LAS VEGAS NV
89146-0360
US

IV. Provider business mailing address

5440 W SAHARA AVE STE 106
LAS VEGAS NV
89146-0360
US

V. Phone/Fax

Practice location:
  • Phone: 702-380-8200
  • Fax: 702-380-3220
Mailing address:
  • Phone: 702-380-8200
  • Fax: 702-380-3220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KRISTY SMITH
Title or Position: OWNER
Credential: NP
Phone: 702-380-8200