Provider Demographics
NPI:1699376558
Name:ALLARD, KODY BRETT (NP-C)
Entity Type:Individual
Prefix:
First Name:KODY
Middle Name:BRETT
Last Name:ALLARD
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8434 E SHEA BLVD STE 1000
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6670
Mailing Address - Country:US
Mailing Address - Phone:602-381-0375
Mailing Address - Fax:866-497-4252
Practice Address - Street 1:6330 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3302
Practice Address - Country:US
Practice Address - Phone:702-901-7953
Practice Address - Fax:866-497-4254
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV835597363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner