Provider Demographics
NPI:1740044627
Name:BYNUM, IREDILA TIMAGOS (APRN FNP-C)
Entity type:Individual
Prefix:MS
First Name:IREDILA
Middle Name:TIMAGOS
Last Name:BYNUM
Suffix:
Gender:
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6070 W POST RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3419
Mailing Address - Country:US
Mailing Address - Phone:385-518-0403
Mailing Address - Fax:385-518-0466
Practice Address - Street 1:6070 W POST RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3419
Practice Address - Country:US
Practice Address - Phone:385-518-0403
Practice Address - Fax:385-518-0466
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN74360163W00000X, 163WW0000X
NV874910363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner