Provider Demographics
NPI:1912361791
Name:IRVEY, TEINESHA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:TEINESHA
Middle Name:MARIE
Last Name:IRVEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 W CHARLESTON BLVD STE 2-421
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7528
Mailing Address - Country:US
Mailing Address - Phone:702-413-7740
Mailing Address - Fax:702-413-7975
Practice Address - Street 1:7650 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2750
Practice Address - Country:US
Practice Address - Phone:702-413-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19768207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV64788OtherMEDICARE
NV1912361791Medicaid