MEDICARE: KRISTINE REBECCA LEAVITT A.P.R.N.

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	363LF0000X	Family Nurse Practitioner	APN001381	NV

General Provider Information

NPI Number	:	1669732434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE REBECCA LEAVITT A.P.R.N.

Provider Business Mailing Address
First Line	:	264 CASA ROBLES ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-4827
Country	:	US
Telephone Number	:	702-249-9747
Fax Number	:

Provider Business Practice Location Address
First Line	:	7469 W LAKE MEAD BLVD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1045
Country	:	US
Telephone Number	:	702-380-8300
Fax Number	:

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

Provider Enumeration Date	:	05/25/2012
Last Update Date	:	09/18/2019

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