Organization Active NPI

Pride Health and Wellness

  • Internal Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1346042876
Registry record updated Jul 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PRIDE HEALTH AND WELLNESS
Practice address
2725 S Jones Blvd Ste 109
Las Vegas, NV 89146-5605
Phone
(702) 350-1477
Fax
(725) 910-0701
NPI assigned
Mar 25, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2026

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

Authorized official

Name
Tyler Russell, APRNNPI 1497472591
Title
Owner
Phone
(702) 350-1477

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

2725 S Jones Blvd Ste 109
Las Vegas, NV 89146-5605

Mailing address

2725 S Jones Blvd Ste 109
Las Vegas, NV 89146-5605
Phone (702) 350-1477

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D2329966Pride Health and Wellness2725 S Jones Blvd, Suite 109, Las Vegas, NV 89146Certificate of waiverSep 8, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1742860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785283200000",
    "number": "1346042876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 S JONES BLVD STE 109",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891465605",
            "telephone_number": "702-350-1477",
            "fax_number": "725-910-0701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2725 S JONES BLVD STE 109",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891465605",
            "telephone_number": "702-350-1477",
            "fax_number": "725-910-0701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIDE HEALTH AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-25",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-350-1477",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jul 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.