Provider Demographics
NPI:1790443497
Name:BALES, ALBERT JAMES (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:JAMES
Last Name:BALES
Suffix:
Gender:M
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 1:291 N PECOS RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1918
Mailing Address - Country:US
Mailing Address - Phone:702-616-9471
Mailing Address - Fax:
Practice Address - Street 1:11345 W PRICKLY PEAR TRL
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-9786
Practice Address - Country:US
Practice Address - Phone:505-322-8858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV848565363LF0000X
AZ266289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV848565OtherNEVADA STATE BOARD OF NURSING
AZ266289OtherARIZONA STATE BOARD OF NURSING