JOHN PHOENIX APRN PLLC NPI 1134553068

NPI Information

NPI: 1134553068
Provider Name: JOHN PHOENIX APRN PLLC

Other Name: HUNTRIDGE FAMILY CLINIC

Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 29D2065859

Address:
1830 E SAHARA AVE STE 201
LAS VEGAS, NV
ZIP 89104
Phone: (702) 979-1111
Get Directions

JOHN PHOENIX APRN PLLC is a family nurse practitioner in Las Vegas, NV. JOHN PHOENIX APRN PLLC NPI is 1134553068. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Huntridge Family Clinic.

The provider's business location address is:

1830 E SAHARA AVE STE 201
LAS VEGAS, NV
ZIP 89104-739
Phone: (702) 979-1111
Fax: (702) 549-6338

The provider's authorized official is John Robert Phoenix .
The authorized official title is Owner and has the following contact phone number (702) 523-9025.

The CLIA number assigned to this NPI record is 29D2065859 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/28/2013 and was last updated on 6/17/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	APRN001359	NEVADA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100534176	MEDICAID	NEVADA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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