Provider Demographics
NPI:1740013184
Name:BATTLEBORN GERIATRICS PLLC
Entity type:Organization
Organization Name:BATTLEBORN GERIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KREK
Authorized Official - Suffix:
Authorized Official - Credentials:AG-ANCP-BC
Authorized Official - Phone:775-303-2377
Mailing Address - Street 1:1073 DORTMUNDER DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89441-5848
Mailing Address - Country:US
Mailing Address - Phone:775-303-2377
Mailing Address - Fax:
Practice Address - Street 1:1073 DORTMUNDER DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89441-5848
Practice Address - Country:US
Practice Address - Phone:775-303-2377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1942076291Medicaid