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NPI Code Detail

MEDICARE: MRS. KELLIE LEANNE VIVION APRN-BC

MEDICARE: MRS. KELLIE LEANNE VIVION APRN-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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner898567NV
2163WE0003XEmergency Registered NurseRN50421NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RN50420OTHERNVLISCENSE NUMBEE

General Provider Information

NPI Number : 1750961173
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLIE LEANNE VIVION APRN-BC
Provider Business Mailing Address
First Line : 102 E LAKE MEAD PKWY
Second Line :
City : HENDERSON
State : NV
Zip : 89015-5575
Country : US
Telephone Number : 702-616-5604
Fax Number :
Provider Business Practice Location Address
First Line : 3001 SAINT ROSE PKWY
Second Line :
City : HENDERSON
State : NV
Zip : 89052-3839
Country : US
Telephone Number : 702-616-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2021
Last Update Date : 02/14/2026

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Directions to “ MRS. KELLIE LEANNE VIVION APRN-BC” Practice Location

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