MEDICARE: KIETRE MEDICAL AND BEHAVIORAL CLINIC

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1194619619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIETRE MEDICAL AND BEHAVIORAL CLINIC

Provider Business Mailing Address
First Line	:	17 SUMMIT CREEK AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-6856
Country	:	US
Telephone Number	:	702-670-0280
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 SUMMIT CREEK AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-6856
Country	:	US
Telephone Number	:	702-670-0280
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	AKISHA TOUSSAINT
Credential	:	APRN, PMHNP, FNP
Telephone Number	:	702-670-0280

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	06/09/2025

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