Healthcare Provider Details

I. General information

NPI: 1386513976
Provider Name (Legal Business Name): TRACY ASHLEY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2025
Last Update Date: 11/01/2025
Certification Date: 11/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 BEL AIR DR UNIT 8C
LAS VEGAS NV
89109-1503
US

IV. Provider business mailing address

3111 BEL AIR DR UNIT 8C
LAS VEGAS NV
89109-1503
US

V. Phone/Fax

Practice location:
  • Phone: 702-756-9145
  • Fax: 702-382-7613
Mailing address:
  • Phone:
  • Fax: 702-382-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN12789
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: