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General NPI Number Information
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NPI Number | 1669187670
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Entity Type | Organization
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Legal Business Name | PERSIA THE PSYCH NP LLC
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 5510 S FORT APACHE RD
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City | LAS VEGAS
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State | NV
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Zip | 89148-7700
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Country | US
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Telephone | 702-848-5520
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Fax |
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Provider Business Mailing Address
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Address Line | 5510 S FORT APACHE RD
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City | LAS VEGAS
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State | NV
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Zip | 89148-7700
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Country | US
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Telephone | 702-848-5520
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PERSIA COLEMAN
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Credential | APRN
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Telephone | 702-848-5520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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