Provider Demographics
NPI:1780064212
Name:SON, KARISA KYUEUN (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:KARISA
Middle Name:KYUEUN
Last Name:SON
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 E DESERT INN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3605
Mailing Address - Country:US
Mailing Address - Phone:702-551-9487
Mailing Address - Fax:702-924-0634
Practice Address - Street 1:2860 E DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3605
Practice Address - Country:US
Practice Address - Phone:702-551-9487
Practice Address - Fax:702-924-0634
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002015363LF0000X, 363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health