MEDICARE: KATHLEEN ROSE AGUSTO TAPALLA APRN, PMHNP-BC

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	829743	NV

General Provider Information

NPI Number	:	1285586875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ROSE AGUSTO TAPALLA APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	3824 S JONES BLVD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2451
Country	:	US
Telephone Number	:	725-205-5601
Fax Number	:

Provider Business Practice Location Address
First Line	:	3824 S JONES BLVD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2451
Country	:	US
Telephone Number	:	725-205-5601
Fax Number	:

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

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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