Healthcare Provider Details

I. General information

NPI: 1679263271
Provider Name (Legal Business Name): JACK JAMES PRATT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MILL ST
RENO NV
89502-1576
US

IV. Provider business mailing address

1155 MILL ST MS M-14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-7878
  • Fax: 775-982-4196
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number839439
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number839439
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number839439
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number839439
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: