NPIMap

Organization Active NPI

Lisa a Durette MD PLLC

Doing business as Healthy Minds

  • Child & Adolescent Psychiatry Physician
  • Las Vegas, NV
National Provider Identifier
1164873246
Registry record updated Nov 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
Legal business name
LISA A DURETTE MD PLLC
Doing business as
Healthy Minds
Practice address
526 S Tonopah Dr Ste 200
Las Vegas, NV 89106-4013
Phone
(702) 440-8440
NPI assigned
Jun 29, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2022

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

Authorized official

Name
Wanda Wilkins
Title
Credentialing Specialist
Phone
(725) 246-1483

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0804X Primary

Addresses

Primary practice location

526 S Tonopah Dr Ste 200
Las Vegas, NV 89106-4013

Mailing address

840 S Rancho Dr Ste 4-337
Las Vegas, NV 89106-3837
Phone (702) 440-8440

Other names 1

  • Healthy Minds Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Office Direct

National Provider Directory

National Provider Directory
Tax ID family
Lisa a Durette MD PLLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

526 S Tonopah Dr
Ste 210
Las Vegas, NV 89106

NPI Registry JSON

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

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668988800000",
    "number": "1164873246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 S RANCHO DR STE 4-337",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891063837",
            "telephone_number": "702-440-8440",
            "fax_number": "866-518-0781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 S TONOPAH DR STE 200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064013",
            "telephone_number": "702-440-8440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA A DURETTE MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-29",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A",
        "authorized_official_last_name": "WILKINS",
        "authorized_official_first_name": "WANDA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "725-246-1483"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Office",
            "affiliation": "N",
            "endpointDescription": "office locations",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Office",
            "address_1": "526 S Tonopah Dr Ste 140-160",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891064043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Healthy Minds",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Healthy Minds",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; 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.