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NPI Code Detail

MEDICARE: BRADY CORD FACKRELL PA-C

MEDICARE: BRADY CORD FACKRELL PA-C
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
1363A00000XPhysician AssistantPA3351NV

General Provider Information

NPI Number : 1366306565
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADY CORD FACKRELL PA-C
Provider Business Mailing Address
First Line : 4785 S DURANGO DR STE 101
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-8167
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4785 S DURANGO DR STE 101
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-8167
Country : US
Telephone Number : 702-889-8444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2025
Last Update Date : 12/11/2025

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Directions to “ BRADY CORD FACKRELL PA-C” Practice Location

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