Provider Demographics
NPI:1326474685
Name:FAILLA, JON (APRN)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:
Last Name:FAILLA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 APACHE TEAR CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2996
Mailing Address - Country:US
Mailing Address - Phone:702-546-6864
Mailing Address - Fax:775-251-9896
Practice Address - Street 1:4270 S DECATUR BLVD STE B6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-6802
Practice Address - Country:US
Practice Address - Phone:702-485-2100
Practice Address - Fax:702-825-0091
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN61345163WP0808X
NVAPRN002252163WP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAPRN002252OtherNEVADA STATE BOARD OF NURSING
NVRN61345OtherNEVADA STATE BOARD OF NURSING