Individual provider Active NPI

Kyle Kimball

  • Family Nurse Practitioner
  • Las Vegas, NV
National Provider Identifier
1215892302
Registry record updated Sep 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
821408 Issued in NV
Practice address
1900 E Desert Inn Rd Ste 5
Las Vegas, NV 89169-3211
Phone
(702) 961-7552
NPI assigned
Dec 19, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 821408 NV Primary

Addresses

Primary practice location

1900 E Desert Inn Rd Ste 5
Las Vegas, NV 89169-3211

Mailing address

1900 E Desert Inn Rd Ste 5
Las Vegas, NV 89169-3211
Phone (702) 961-7552

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260623000611 NV Practitioner - Nurse Practitioner 6305319286 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nevada Burn and Reconstruction Coates LTDGroup PAC ID 4789044926, 8 clinicians

Practice addresses (Care Compare)

3196 S Maryland Pkwy
Las Vegas, NV 89109-2305
Phone (702) 961-7552

Hospital & facility affiliations

  • Sunrise Hospital and Medical Center Hospital, Las Vegas, NV, CCN 290003

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
821408NVMDFamily Nurse Practitioner

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1766102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788393600000",
    "number": "1215892302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 E DESERT INN RD STE 5",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891693211",
            "telephone_number": "702-961-7552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 E DESERT INN RD STE 5",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891693211",
            "telephone_number": "702-961-7552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "KYLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-12-19",
        "last_updated": "2026-09-03",
        "certification_date": "2026-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "821408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.