Provider Demographics
NPI:1033846092
Name:PACHECO, BRYCE (APRN-BC)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:PACHECO
Suffix:
Gender:M
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8517 ARCO IRIS LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7952
Mailing Address - Country:US
Mailing Address - Phone:702-501-2076
Mailing Address - Fax:
Practice Address - Street 1:715 MALL RING CIR STE 202
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6667
Practice Address - Country:US
Practice Address - Phone:702-483-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV857051363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care