Healthcare Provider Details

I. General information

NPI: 1740013184
Provider Name (Legal Business Name): BATTLEBORN GERIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1073 DORTMUNDER DR
SPARKS NV
89441-5848
US

IV. Provider business mailing address

1073 DORTMUNDER DR
SPARKS NV
89441-5848
US

V. Phone/Fax

Practice location:
  • Phone: 775-303-2377
  • Fax:
Mailing address:
  • Phone: 775-303-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BLAKE KREK
Title or Position: APRN/OWNER
Credential: AG-ANCP-BC
Phone: 775-303-2377