Healthcare Provider Details

I. General information

NPI: 1083076269
Provider Name (Legal Business Name): KRISTOPHER KEVIN KLEINMAN R.N, N.P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 PAINTED MIRAGE RD STE 217
LAS VEGAS NV
89149
US

IV. Provider business mailing address

11752 VIA ESPERANZA AVE
LAS VEGAS NV
89138-6025
US

V. Phone/Fax

Practice location:
  • Phone: 702-410-9800
  • Fax:
Mailing address:
  • Phone: 801-792-8012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN82632
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number810017
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: