Healthcare Provider Details

I. General information

NPI: 1164787867
Provider Name (Legal Business Name): MISS BRIDGET ANN ESPY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W CHEYENNE AVE APT 1025
NORTH LAS VEGAS NV
89030-7830
US

IV. Provider business mailing address

2801 S VALLEY VIEW BLVD STE 11
LAS VEGAS NV
89102-0176
US

V. Phone/Fax

Practice location:
  • Phone: 702-917-2227
  • Fax:
Mailing address:
  • Phone: 702-629-5815
  • Fax: 702-629-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: