Healthcare Provider Details

I. General information

NPI: 1104243112
Provider Name (Legal Business Name): NAKEIA FUNCHES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date: 11/08/2024
Reactivation Date: 11/21/2024

III. Provider practice location address

3305 SPRING MOUNTAIN RD STE 107
LAS VEGAS NV
89102-8628
US

IV. Provider business mailing address

3305 SPRING MOUNTAIN RD STE 107
LAS VEGAS NV
89102-8628
US

V. Phone/Fax

Practice location:
  • Phone: 702-487-5480
  • Fax:
Mailing address:
  • Phone: 702-487-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: