Healthcare Provider Details

I. General information

NPI: 1346125069
Provider Name (Legal Business Name): KRISTY CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 S FORT APACHE RD
LAS VEGAS NV
89117-0738
US

IV. Provider business mailing address

3290 S FORT APACHE RD
LAS VEGAS NV
89117-0738
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number891480
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: