Provider Demographics
NPI:1669732434
Name:LEAVITT, KRISTINE REBECCA (APRN)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:REBECCA
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 CASA ROBLES ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4827
Mailing Address - Country:US
Mailing Address - Phone:702-249-9747
Mailing Address - Fax:
Practice Address - Street 1:7469 W LAKE MEAD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1045
Practice Address - Country:US
Practice Address - Phone:702-380-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001381363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily