Provider Demographics
NPI:1770583726
Name:NIELSON, KYLE PRATT (MD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:PRATT
Last Name:NIELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KYLE
Other - Middle Name:PRATT
Other - Last Name:HANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9790 BRIGHT ANGEL WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-1332
Mailing Address - Country:US
Mailing Address - Phone:702-235-4955
Mailing Address - Fax:
Practice Address - Street 1:VA SOUTHERN NEVADA HEALTHCARE SYSTEM
Practice Address - Street 2:6900 NORTH PECOS ROAD
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-799-9000
Practice Address - Fax:702-224-6937
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV55472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV200262806Medicaid
NV200262806Medicaid
NV30WCHCC04Medicare ID - Type Unspecified