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NPI Code Detail

MEDICARE: NYESHIA DENISE MATLOCK

MEDICARE: NYESHIA DENISE MATLOCK
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1770477358
Entity Type Code : Individual
Provider Name (Legal Business Name) : NYESHIA DENISE MATLOCK
Provider Business Mailing Address
First Line : 8936 SPANISH RIDGE AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-1354
Country : US
Telephone Number : 702-994-6175
Fax Number :
Provider Business Practice Location Address
First Line : 8936 SPANISH RIDGE AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-1354
Country : US
Telephone Number : 702-994-6175
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2025
Last Update Date : 06/06/2025

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Directions to “ NYESHIA DENISE MATLOCK ” Practice Location

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