MEDICARE: MR. RAVI KUMAR FNP

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	810857	NV

General Provider Information

NPI Number	:	1679270177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAVI KUMAR FNP

Provider Business Mailing Address
First Line	:	5540 STERLING VALLEY CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4671
Country	:	US
Telephone Number	:	702-526-7057
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 WELLNESS WAY STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4146
Country	:	US
Telephone Number	:	702-310-9110
Fax Number	:

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

Provider Enumeration Date	:	02/14/2023
Last Update Date	:	02/14/2023

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