=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396500138
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEILANI C CARNEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2024
-----------------------------------------------------
Last Update Date | 09/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2801 N TENAYA WAY STE C
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89128-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-684-7800
-----------------------------------------------------
Fax | 702-684-7878
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9620 W RUSSELL RD APT 2029
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89148-4509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-941-2367
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 811220
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------