MEDICARE: KRISTOPHER J IVEY M.D.

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	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	84735	GA
2	207P00000X	Emergency Medicine Physician	53286	TN
3	207P00000X	Emergency Medicine Physician	84735	GA
4	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	53286	TN
5	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	17761	NV
6	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	17761	NV

General Provider Information

NPI Number	:	1346507076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTOPHER J IVEY M.D.

Provider Business Mailing Address
First Line	:	2144 STARLINE MEADOW PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6648
Country	:	US
Telephone Number	:	478-737-8036
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102
Country	:	US
Telephone Number	:	702-383-7338
Fax Number	:

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

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	01/19/2026

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