Healthcare Provider Details

I. General information

NPI: 1326474685
Provider Name (Legal Business Name): JON FAILLA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4270 S DECATUR BLVD STE B6
LAS VEGAS NV
89103-6802
US

IV. Provider business mailing address

182 APACHE TEAR CT
LAS VEGAS NV
89123-2996
US

V. Phone/Fax

Practice location:
  • Phone: 702-485-2100
  • Fax: 702-825-0091
Mailing address:
  • Phone: 702-546-6864
  • Fax: 775-251-9896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN61345
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberAPRN002252
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002252
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: