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General NPI Number Information
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NPI Number | 1144889502
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Entity Type | Individual
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Provider Name | HEATHER POULOS PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 2225 CIVIC CENTER DR STE 224
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89030-6332
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Country | US
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Telephone | 702-214-5948
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Fax | 702-214-9439
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Provider Business Mailing Address
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Address Line | 3900 CAMBRIDGE ST STE 102
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City | LAS VEGAS
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State | NV
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Zip | 89119-7440
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Country | US
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Telephone | 702-307-5414
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Fax | 702-307-5416
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2161
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License Number State | NV
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