Provider Demographics
NPI:1750167607
Name:WISE, AMY LYN (ARPN-CNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYN
Last Name:WISE
Suffix:
Gender:F
Credentials:ARPN-CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8880 W SUNSET RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5014
Mailing Address - Country:US
Mailing Address - Phone:702-805-5360
Mailing Address - Fax:
Practice Address - Street 1:8880 W SUNSET RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5014
Practice Address - Country:US
Practice Address - Phone:702-805-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV868856363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty