Provider Demographics
NPI:1972047629
Name:O'CONNELL, CRISTY DAWN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:CRISTY
Middle Name:DAWN
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9620 LAS VEGAS BLVD S STE E4-118
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-6507
Mailing Address - Country:US
Mailing Address - Phone:702-992-3688
Mailing Address - Fax:702-992-3181
Practice Address - Street 1:11201 S EASTERN AVE STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-6200
Practice Address - Country:US
Practice Address - Phone:702-992-3688
Practice Address - Fax:702-992-3181
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002449363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1972047629Medicaid
NVV58917OtherMEDICARE PTAN
NVAPRN002449OtherSTATE LICENSE