Provider Demographics
NPI:1205594710
Name:BACOTE, KYRAH L (DC, MDN, LMTBW)
Entity type:Individual
Prefix:DR
First Name:KYRAH
Middle Name:L
Last Name:BACOTE
Suffix:
Gender:F
Credentials:DC, MDN, LMTBW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MIKE O'CALLAGHAN MILITARY MEDICAL CENTER
Mailing Address - Street 2:4700 LAS VEGAS N
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-8762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MIKE O'CALLAGHAN MILITARY MEDICAL CENTER
Practice Address - Street 2:4700 LAS VEGAS BLVD N
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89191
Practice Address - Country:US
Practice Address - Phone:702-679-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01882111N00000X, 202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV202D00000XOtherINTEGRATIVE MEDICINE PHYSICIAN