MEDICARE: NEYKY FERNANDEZ-GONZALEZ APRN-CNP

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	163W00000X	Registered Nurse	859959	NV
2	363LC1500X	Community Health Nurse Practitioner	859959	NV
3	363LP2300X	Primary Care Nurse Practitioner	859959	NV
4	363LF0000X	Family Nurse Practitioner	859959	NV
5	101Y00000X	Counselor

General Provider Information

NPI Number	:	1811346380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEYKY FERNANDEZ-GONZALEZ APRN-CNP

Provider Business Mailing Address
First Line	:	5130 S PECOS RD STE 1A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1248
Country	:	US
Telephone Number	:	702-742-8235
Fax Number	:

Provider Business Practice Location Address
First Line	:	5130 S PECOS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1201
Country	:	US
Telephone Number	:	24-105-0907
Fax Number	:

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

Provider Enumeration Date	:	06/06/2016
Last Update Date	:	01/16/2025

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