Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 53286 | TN |
N | 207PE0004X | Emergency Medical Services | 17761 | NV |
Y | 207PP0204X | Pediatric Emergency Physician | 17761 | NV |
N | 207PP0204X | Pediatric Emergency Physician | 53286 | TN |
NPI | 1346507076 |
---|---|
Provider Name | Kristopher J Ivey |
First Address | Las Vegas, NV 89134-6648 |
Second Address | Las Vegas, NV 89102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2012 |
Last Update Date | 27/06/2018 |