Provider Demographics
NPI:1902540974
Name:REGENCY PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:REGENCY PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:KWOWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-490-1505
Mailing Address - Street 1:1116 W PARKER RD STE 308A
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-2273
Mailing Address - Country:US
Mailing Address - Phone:469-490-1505
Mailing Address - Fax:469-490-1516
Practice Address - Street 1:5121 BLUE ROSE ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-2678
Practice Address - Country:US
Practice Address - Phone:469-490-1505
Practice Address - Fax:469-490-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX443587701Medicaid