MEDICARE: YVETTE WALKER-WITHERSPOON

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	374K00000X	Religious Nonmedical Practitioner

General Provider Information

NPI Number	:	1912618216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVETTE WALKER-WITHERSPOON

Provider Business Mailing Address
First Line	:	2125 LAS VEGAS BLVD N APT 1094
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-5890
Country	:	US
Telephone Number	:	562-415-4620
Fax Number	:	888-725-8902

Provider Business Practice Location Address
First Line	:	8275 S EASTERN AVE STE 119
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2544
Country	:	US
Telephone Number	:	562-415-4620
Fax Number	:	888-725-8902

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

Provider Enumeration Date	:	12/07/2022
Last Update Date	:	12/07/2022

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Directions to “ YVETTE WALKER-WITHERSPOON ” Practice Location

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