=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881283257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASHLEY NICOLE JUSTE PLLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2021
-----------------------------------------------------
Last Update Date | 02/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9425 SAYAN CIR
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89149-1665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-722-8984
-----------------------------------------------------
Fax | 866-656-3395
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7181 N HUALAPAI WAY # 130-200
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89166-1115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-751-4192
-----------------------------------------------------
Fax | 866-656-3395
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. ASHLEY NICOLE JUSTE
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 702-722-8984
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------