Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 845035 | NV |
NPI | 1023625688 |
---|---|
Provider Name | Jerri L Bracey |
First Address | Las Vegas, NV 89178-2902 |
Second Address | Las Vegas, NV 89178-2902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2020 |
Last Update Date | 04/11/2021 |