Healthcare Provider Details

I. General information

NPI: 1578005658
Provider Name (Legal Business Name): DALLAN MCKEE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E DESERT INN RD STE 100
LAS VEGAS NV
89121-3609
US

IV. Provider business mailing address

2800 E DESERT INN RD STE 100
LAS VEGAS NV
89121-3609
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-1616
  • Fax: 702-734-4900
Mailing address:
  • Phone: 702-731-1616
  • Fax: 702-734-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN76812
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002386
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberAPRN002386
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: