MEDICARE: ASHLYNE ROSE DONOVAN MOSER 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	859295	NV

General Provider Information

NPI Number	:	1578491759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLYNE ROSE DONOVAN MOSER PMHNP-BC

Provider Business Mailing Address
First Line	:	2110 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5190
Country	:	US
Telephone Number	:	725-331-1100
Fax Number	:	725-331-1200

Provider Business Practice Location Address
First Line	:	2110 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5190
Country	:	US
Telephone Number	:	725-331-1100
Fax Number	:	725-331-1200

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

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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