Healthcare Provider Details

I. General information

NPI: 1740855097
Provider Name (Legal Business Name): PEBBLES PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 01/04/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 COURT STREET LOWER LEVEL SUITE D
RENO NV
89501
US

IV. Provider business mailing address

PO BOX 51630
SPARKS NV
89435-1630
US

V. Phone/Fax

Practice location:
  • Phone: 775-418-5990
  • Fax: 775-418-5991
Mailing address:
  • Phone: 775-418-5990
  • Fax: 775-418-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. CHRISTINE YVETTE PEBBLES
Title or Position: PSYCHIATRIC NP/OWNER
Credential: DNP, APRN, PMHNP-BC
Phone: 775-418-5990