Provider Demographics
NPI:1861845059
Name:ADVANCED CLINICAL PROFESSIONALS OF NEVADA
Entity Type:Organization
Organization Name:ADVANCED CLINICAL PROFESSIONALS OF NEVADA
Other - Org Name:SILVER STATE PAIN AND INJURY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:BC-NP
Authorized Official - Phone:702-613-1190
Mailing Address - Street 1:7670 W SAHARA AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2751
Mailing Address - Country:US
Mailing Address - Phone:702-613-1190
Mailing Address - Fax:702-457-7401
Practice Address - Street 1:7670 W SAHARA AVE STE 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2751
Practice Address - Country:US
Practice Address - Phone:702-457-7400
Practice Address - Fax:702-457-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001449363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty