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NPI Code Detail

MEDICARE: DALLIN STEPHEN RALPH JOHNSON PMHNP-BC

MEDICARE: DALLIN STEPHEN RALPH JOHNSON 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
1364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist833966NV

General Provider Information

NPI Number : 1730910415
Entity Type Code : Individual
Provider Name (Legal Business Name) : DALLIN STEPHEN RALPH JOHNSON PMHNP-BC
Provider Business Mailing Address
First Line : 6600 W CHARLESTON BLVD STE 142
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-1050
Country : US
Telephone Number : 702-440-8430
Fax Number :
Provider Business Practice Location Address
First Line : 6600 W CHARLESTON BLVD STE 142
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-1050
Country : US
Telephone Number : 702-440-8430
Fax Number : 866-640-0525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2024
Last Update Date : 08/13/2024

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Directions to “ DALLIN STEPHEN RALPH JOHNSON PMHNP-BC” Practice Location

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