NPIMap

Individual provider Active NPI

Greggy Oliver King

  • Family Nurse Practitioner
  • Las Vegas, NV
National Provider Identifier
1417794280
Registry record updated Oct 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
880158 Issued in NV
Practice address
701 Shadow LN Ste 300
Las Vegas, NV 89106-4133
Phone
(702) 383-1919
Fax
(702) 383-2283
NPI assigned
Jul 10, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2025

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 880158 NV Primary

Addresses

Primary practice location

701 Shadow LN Ste 300
Las Vegas, NV 89106-4133

Mailing address

1800 W Charleston Blvd
Las Vegas, NV 89102-2386
Phone (702) 383-2620

Other practice location 1

4212 W Charleston Blvd
Las Vegas, NV 89102-1625
Phone (702) 312-2233

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250821003998 NV Practitioner - Nurse Practitioner 4183124423 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

701 Shadow LN
Suite 300
Las Vegas, NV 89106-4133
Phone (702) 671-6191

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Center of Southern Nevada CurrentSince Aug 18, 2025 Accepting new patients
University Medical Center of Southern Nevada CurrentSince Aug 18, 2025 Accepting new patients

Locations

1800 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 207-8253

701 Shadow Ln
Ste 300
Las Vegas, NV 89106
Phone (702) 383-1919

Organizations & group practices 2

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 12

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": "1720569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760486400000",
    "number": "1417794280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 W CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022386",
            "telephone_number": "702-383-2620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 SHADOW LN STE 300",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064133",
            "telephone_number": "702-383-1919",
            "fax_number": "702-383-2283"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4212 W Charleston Blvd",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891021625",
            "country_code": "US",
            "telephone_number": "702-312-2233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KING",
        "first_name": "GREGGY OLIVER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-07-10",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "880158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.