Palm Tree Medical Center LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

PALM TREE MEDICAL CENTER LLC

Practice address

3930 E Patrick LN
Las Vegas, NV 89120-4924

Phone

(725) 577-8636

NPI assigned

Oct 12, 2021

Organization subpart

No

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

Authorized official

Name

Jacolby Bledsoe

Title

Owner

Phone

(725) 577-8636

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1633996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634083200000",
    "number": "1073275442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3930 E PATRICK LN",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891204924",
            "telephone_number": "725-577-8636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 E PATRICK LN",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891204924",
            "telephone_number": "725-577-8636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM TREE MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-12",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A",
        "authorized_official_last_name": "BLEDSOE",
        "authorized_official_first_name": "JACOLBY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "725-577-8636"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaycee Pallones, RN
• Sufia Palluck, D.D.S.
• Palm Home LLC
• Palm Medical Group LLC
• Palm Medical Group, Nakhle MD, PLLC
• Deandre Damar Palm
• Lavatta Carlette Palm
• Ana Isabel Palma Hernandez
• Palma Holdings LLC
• Juan Carlos Palma Jorge

• Primary Care Nurse Practitioner in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Primary Care Nurse Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; 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.