Gwendolyn Ivy

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

812191 Issued in NV

Practice address

5412 Boulder Hwy
Las Vegas, NV 89122-6039

Phone

(702) 291-7121

NPI assigned

Sep 25, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569369600000",
    "number": "1053962522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9623 BIGHORN RANCH AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891484221",
            "telephone_number": "773-656-1525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5412 BOULDER HWY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891226039",
            "telephone_number": "702-291-7121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVY",
        "first_name": "GWENDOLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-25",
        "last_updated": "2019-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "NV",
            "license": "812191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jocelyn Quebral Ivie, MD
• Donell Ivory
• Jarreau Lamarr Ivory
• Ivy Counseling LLC
• Ivy Dental Inc.
• Marshon Ivy
• Ngozi Ivy
• Pamela Ivy
• Mousa Iwais
• Craig L Iwamoto, M.D.

• Psychiatric/Mental Health Registered Nurse in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Psychiatric/Mental Health Registered Nurse in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.