Provider Demographics
NPI:1669143871
Name:SHIRAISHI, KAYDEE MARIE (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KAYDEE
Middle Name:MARIE
Last Name:SHIRAISHI
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:KAYDEE
Other - Middle Name:MARIE
Other - Last Name:TRICKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4880 WYNN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-5406
Mailing Address - Country:US
Mailing Address - Phone:702-430-3820
Mailing Address - Fax:
Practice Address - Street 1:4880 WYNN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5406
Practice Address - Country:US
Practice Address - Phone:702-430-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV845192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine