Provider Demographics
NPI:1780135145
Name:GREGORY, KAM-LIN D (APRN-CNM)
Entity type:Individual
Prefix:
First Name:KAM-LIN
Middle Name:D
Last Name:GREGORY
Suffix:
Gender:F
Credentials:APRN-CNM
Other - Prefix:
Other - First Name:KAM-LIN
Other - Middle Name:
Other - Last Name:FANSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNM
Mailing Address - Street 1:10624 S EASTERN AVE STE A-873
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2982
Mailing Address - Country:US
Mailing Address - Phone:702-478-5111
Mailing Address - Fax:702-602-9012
Practice Address - Street 1:3039 W HORIZON RIDGE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4193
Practice Address - Country:US
Practice Address - Phone:702-478-5111
Practice Address - Fax:702-602-9012
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV852141367A00000X, 367A00000X
CA235819367A00000X
CO0996521367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife