JOHANNA S. FRICKE M.D. LLC NPI 1790108264

NPI Information

NPI: 1790108264
Provider Name: JOHANNA S. FRICKE, M.D., LLC
Classification: Pediatrics - 2080P0006X
Entity Type: Organization

Specialization: Developmental - Behavioral Pediatrics

Address:
311 N BUFFALO DR
SUITE B
LAS VEGAS, NV
ZIP 89145
Phone: (702) 877-2520
Get Directions

JOHANNA S. FRICKE, M.D., LLC is a developmental - behavioral pediatrics pediatrics in Las Vegas, NV. The provider is a developmental-behavioral specialist is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care and advocacy efforts. This physician assists in the prevention, diagnosis, and management of developmental difficulties and problematic behaviors in children and in the family dysfunctions that compromise children's development. JOHANNA S. FRICKE, M.D., LLC NPI is 1790108264. The provider is registered as an organization entity type.

The provider's business location address is:

311 N BUFFALO DR
SUITE B
LAS VEGAS, NV
ZIP 89145-375
Phone: (702) 877-2520
Fax: (702) 877-2521

The provider's authorized official is Johanna Fricke .
The authorized official title is Physician/ceo and has the following contact phone number (702) 804-9065.

The enumeration date for this NPI number is 2/3/2014 and was last updated on 3/7/2023.

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 State	Primary
1	261QD1600X	Clinic/Center	Developmental Disabilities	NEVADA	No
2	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	NEVADA	No
3	261QM2500X	Clinic/Center	Medical Specialty	NEVADA	No
4	2080P0006X	Pediatrics	Developmental - Behavioral Pediatrics	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	32876	OTHER	NEVADA	MEDICARE ID-TYPE UNSPECIFIED/MEDICARE
2	002002223	MEDICAID	NEVADA
3	CS09750	OTHER	NEVADA	STATE PHARMACY
4	003102223	OTHER	NEVADA	MEDICARE ID-TYPE UNSPECIFIED/NV MEDICAID

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: 4/28/2024

NPI Synchronization or Removal

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