Healthcare Provider Details

I. General information

NPI: 1629486113
Provider Name (Legal Business Name): VITALITY MEDICAL AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 06/22/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5765 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-5625
US

IV. Provider business mailing address

5765 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-5625
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-1200
  • Fax: 702-736-6302
Mailing address:
  • Phone: 702-731-1200
  • Fax: 702-736-6302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN37436
License Number StateNV

VIII. Authorized Official

Name: CRISTY M THOMAS
Title or Position: PROVIDER/OWNER
Credential: DNP
Phone: 702-731-1200