Healthcare Provider Details

I. General information

NPI: 1447734751
Provider Name (Legal Business Name): KURT COLTER SAWYER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BERTHA HOWE AVE STE 1
MESQUITE NV
89027-7503
US

IV. Provider business mailing address

457 PARKVIEW DR
MESQUITE NV
89027-3113
US

V. Phone/Fax

Practice location:
  • Phone: 702-346-0800
  • Fax:
Mailing address:
  • Phone: 435-590-6960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number814943
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: