MEDICARE: HYBRID HEALTHCARE PRO

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1568256048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HYBRID HEALTHCARE PRO

Provider Business Mailing Address
First Line	:	557 ASPEN LEAF ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-4563
Country	:	US
Telephone Number	:	702-704-9251
Fax Number	:

Provider Business Practice Location Address
First Line	:	2407 W CHARLESTON BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2138
Country	:	US
Telephone Number	:	702-279-3460
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	BETHANY WILLIAMS
Credential	:	NP
Telephone Number	:	702-704-9251

Provider Enumeration Date	:	04/08/2025
Last Update Date	:	04/08/2025

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Directions to “HYBRID HEALTHCARE PRO ” Practice Location

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