MEDICARE: SOUTHWEST PRESTIGE PEDIATRICS & AESTHETICS PLLC

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	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1194603514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST PRESTIGE PEDIATRICS & AESTHETICS PLLC

Provider Business Mailing Address
First Line	:	9475 S RAINBOW BLVD STE B120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6701
Country	:	US
Telephone Number	:	702-508-3040
Fax Number	:	702-800-8442

Provider Business Practice Location Address
First Line	:	9475 S RAINBOW BLVD
Second Line	:	SUITE B120, STUDIO 11
City	:	LAS VEGAS
State	:	NV
Zip	:	89139
Country	:	US
Telephone Number	:	702-508-3040
Fax Number	:

Authorized Official
Title or Position	:	OWNER/NURSE PRACTITIONER
Name	:	MRS. KAYLA L SWEENEY
Credential	:	FNP
Telephone Number	:	702-508-3040

Provider Enumeration Date	:	08/25/2025
Last Update Date	:	04/16/2026

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