Provider Demographics
NPI:1033302252
Name:LAS VEGAS PSYCHIATRY LLC
Entity Type:Organization
Organization Name:LAS VEGAS PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHILD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-227-4165
Mailing Address - Street 1:3501 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1839
Mailing Address - Country:US
Mailing Address - Phone:702-227-4165
Mailing Address - Fax:702-227-7921
Practice Address - Street 1:3501 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1839
Practice Address - Country:US
Practice Address - Phone:702-227-4165
Practice Address - Fax:702-227-7921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN00448363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q13894Medicare UPIN