MEDICARE: MINDBODY OASIS PLLC

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	101YM0800X	Mental Health Counselor
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1972431146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDBODY OASIS PLLC

Provider Business Mailing Address
First Line	:	2080 E FLAMINGO RD STE 312
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5181
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 E FLAMINGO RD STE 312
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5181
Country	:	US
Telephone Number	:	702-670-0977
Fax Number	:

Authorized Official
Title or Position	:	ARNP
Name	:	GRACE J KORIR
Credential	:	FNP C,PMHNP-BC
Telephone Number	:	702-812-0925

Provider Enumeration Date	:	05/09/2026
Last Update Date	:	05/09/2026

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