Provider Demographics
NPI:1659812212
Name:ASBURY, ANNETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:ASBURY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 E RUSSELL RD BLDG 5
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3802
Mailing Address - Country:US
Mailing Address - Phone:702-659-6138
Mailing Address - Fax:702-381-5383
Practice Address - Street 1:4020 E RUSSELL RD BLDG 5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3802
Practice Address - Country:US
Practice Address - Phone:702-659-6138
Practice Address - Fax:702-381-5383
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002538363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty