MEDICARE: MRS. KRISTINA MARIE MCGAHAN RN

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	163WW0101X	Ambulatory Women's Health Care Registered Nurse	RN48115	NV
2	363LW0102X	Women's Health Nurse Practitioner	888067	NV

General Provider Information

NPI Number	:	1164289971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINA MARIE MCGAHAN RN

Provider Business Mailing Address
First Line	:	9090 W POST RD # 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2419
Country	:	US
Telephone Number	:	702-382-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	9090 W POST RD # 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2419
Country	:	US
Telephone Number	:	702-382-3200
Fax Number	:

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

Provider Enumeration Date	:	02/28/2024
Last Update Date	:	05/15/2025

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