Provider Demographics
NPI:1710925466
Name:TUNNELL, CELESTE (PA-C)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:TUNNELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8850 WEST SUNSET RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148
Mailing Address - Country:US
Mailing Address - Phone:702-740-0500
Mailing Address - Fax:702-740-0502
Practice Address - Street 1:8850 WEST SUNSET RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-740-0500
Practice Address - Fax:702-740-0502
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA655363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505297Medicaid
P25194Medicare UPIN
NV100505297Medicaid