Healthcare Provider Details

I. General information

NPI: 1245833235
Provider Name (Legal Business Name): DESERT SKY MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 PINNACLE CT BLDG 10
MESQUITE NV
89027-3303
US

IV. Provider business mailing address

840 PINNACLE CT BLDG 10
MESQUITE NV
89027-3303
US

V. Phone/Fax

Practice location:
  • Phone: 775-225-1414
  • Fax: 775-225-1415
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTY LEANY
Title or Position: OWNER
Credential: NP
Phone: 435-669-0984