Provider Demographics
NPI:1902573769
Name:KAUR, SUPREET (FNP-C)
Entity Type:Individual
Prefix:
First Name:SUPREET
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 PAINTED RIVER LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7300
Mailing Address - Country:US
Mailing Address - Phone:818-748-7337
Mailing Address - Fax:
Practice Address - Street 1:1725 S RAINBOW BLVD STE 18
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0033
Practice Address - Country:US
Practice Address - Phone:702-992-3688
Practice Address - Fax:702-992-3181
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV844872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily