Provider Demographics
NPI:1598372088
Name:ARES, KENNETH R (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:R
Last Name:ARES
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10729 SAPPHIRE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4139
Mailing Address - Country:US
Mailing Address - Phone:702-596-2188
Mailing Address - Fax:
Practice Address - Street 1:8430 W LAKE MEAD BLVD
Practice Address - Street 2:STE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7674
Practice Address - Country:US
Practice Address - Phone:888-499-9273
Practice Address - Fax:702-926-9658
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV834300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV834300OtherAPRN-CNP