MEDICARE: CONSUELO KIRK APRN

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	817863	NV

General Provider Information

NPI Number	:	1073049631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSUELO KIRK APRN

Provider Business Mailing Address
First Line	:	112 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2614
Country	:	US
Telephone Number	:	702-909-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-5002
Country	:	US
Telephone Number	:	316-841-7350
Fax Number	:

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

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	09/26/2025

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Directions to “ CONSUELO KIRK APRN” Practice Location

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