MEDICARE: JERRI L BRACEY DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN68945	NV
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	845035	NV

General Provider Information

NPI Number	:	1023625688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRI L BRACEY DNP

Provider Business Mailing Address
First Line	:	10058 CLOUD BREAK ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-2902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10058 CLOUD BREAK ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-2902
Country	:	US
Telephone Number	:	702-375-7823
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2020
Last Update Date	:	11/04/2021

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