Raven Ennis

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN002372 Issued in NV

Practice address

4270 S Decatur Blvd Ste B6
Las Vegas, NV 89103-6802

Phone

(702) 485-2100

Fax

(702) 825-0091

NPI assigned

Jan 6, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Southern Nevada Health District

  • Community Health Clinic/Center
  • Las Vegas, NV
  • NPI 1275550212
  NPD (past)

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

{
    "created_epoch": "1388966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1407278757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4270 S DECATUR BLVD STE B6",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891036802",
            "telephone_number": "702-485-2100",
            "fax_number": "702-825-0091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4270 S DECATUR BLVD STE B6",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891036802",
            "telephone_number": "702-485-2100",
            "fax_number": "702-825-0091"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "330 S Valley View Blvd",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891074361",
            "country_code": "US",
            "telephone_number": "702-759-0882",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "RAVEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-06",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NV",
            "license": "RN73437",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NV",
            "license": "APRN002372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Lamar Ennis
• Khamphanh Ennis
• Kristy Durie Ennis
• Latarsha Ennis
• Meshayla Ennis
• Kaitlin Virginia Enoch
• Ashlyn Marie Enokian
• Malia Enos
• Elizabeth Anne Enox
• Enrich Motion Physical Therapy and Wellness PLLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 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.