MEDICARE: LAS VEGAS PSYCHIATRY LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN00448	NV

General Provider Information

NPI Number	:	1033302252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	3501 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1839
Country	:	US
Telephone Number	:	702-227-4165
Fax Number	:	702-227-7921

Provider Business Practice Location Address
First Line	:	3501 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1839
Country	:	US
Telephone Number	:	702-227-4165
Fax Number	:	702-227-7921

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MR. CURTIS D CHILD
Credential	:	APRN
Telephone Number	:	702-227-4165

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	08/21/2007

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