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General NPI Number Information
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NPI Number | 1437967320
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Entity Type | Organization
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Legal Business Name | HAILSTONE FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 9065 S PECOS RD STE 190
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City | HENDERSON
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State | NV
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Zip | 89074-6605
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Country | US
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Telephone | 725-485-2080
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Fax | 885-576-5067
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Provider Business Mailing Address
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Address Line | 9065 S PECOS ROAD SUITE 190
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City | HENDERSON
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State | NV
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Zip | 89074-4539
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Country | US
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Telephone | 725-485-2080
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Fax | 885-576-5067
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. TRAVIS HAILSTONE
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Credential | DO
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Telephone | 725-485-2080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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