Provider Demographics
NPI:1821687427
Name:MEYER, BRIAN ELLIOT
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ELLIOT
Last Name:MEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9110 W TROPICANA AVE UNIT 162
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8152
Mailing Address - Country:US
Mailing Address - Phone:702-343-7736
Mailing Address - Fax:
Practice Address - Street 1:9110 W TROPICANA AVE UNIT 162
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8152
Practice Address - Country:US
Practice Address - Phone:702-343-7736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV837642363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health