Healthcare Provider Details

I. General information

NPI: 1235404328
Provider Name (Legal Business Name): DARYLRIKA KLINGLESMITH M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6277 SHINER BOCK CT
NORTH LAS VEGAS NV
89081-6405
US

IV. Provider business mailing address

6277 SHINER BOCK CT
NORTH LAS VEGAS NV
89081-6405
US

V. Phone/Fax

Practice location:
  • Phone: 702-815-9567
  • Fax:
Mailing address:
  • Phone: 702-815-9567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: