Provider Demographics
NPI:1225513625
Name:KIZER, OMARR
Entity Type:Individual
Prefix:
First Name:OMARR
Middle Name:
Last Name:KIZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 WYNN RD APT 706
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-2849
Mailing Address - Country:US
Mailing Address - Phone:702-772-2805
Mailing Address - Fax:
Practice Address - Street 1:3800 WYNN RD APT 706706G
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2800
Practice Address - Country:US
Practice Address - Phone:702-772-2805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide