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General NPI Number Information
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NPI Number | 1104618214
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Entity Type | Individual
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Provider Name | KIDIST ASAYE APRN
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Gender | Female
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 1597 E WINDMILL LN STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89123-1921
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Country | US
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Telephone | 725-251-5175
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Fax |
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Provider Business Mailing Address
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Address Line | 6948 PACIFIC COAST ST
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City | LAS VEGAS
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State | NV
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Zip | 89148-2823
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Country | US
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Telephone | 702-927-0677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 824055
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License Number State | NV
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