Provider Demographics
NPI:1508802075
Name:NESSA, KRISTAL M (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:M
Last Name:NESSA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTAL
Other - Middle Name:M
Other - Last Name:NESSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PAC
Mailing Address - Street 1:2647 BOX CANYON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0450
Mailing Address - Country:US
Mailing Address - Phone:702-363-5575
Mailing Address - Fax:702-646-1727
Practice Address - Street 1:2647 BOX CANYON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0450
Practice Address - Country:US
Practice Address - Phone:702-363-5575
Practice Address - Fax:702-646-1727
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA868363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509668Medicaid