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General NPI Number Information
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NPI Number | 1013862937
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Entity Type | Organization
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Legal Business Name | MODERN PSYCHIATRY
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Dates
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Enumeration Date | 03/04/2026
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 6675 S TENAYA WAY
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City | LAS VEGAS
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State | NV
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Zip | 89113-1930
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Country | US
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Telephone | 702-318-7920
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Fax | 702-442-8150
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Provider Business Mailing Address
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Address Line | 6675 S TENAYA WAY
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City | LAS VEGAS
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State | NV
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Zip | 89113-1930
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Country | US
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Telephone | 702-318-7920
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Fax | 702-442-8150
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Authorized Official
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Title or Position | BILLER
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Name | MARY CONRADY
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Credential |
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Telephone | 702-318-7920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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