Stark Medicine

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

STARK MEDICINE

Practice address

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

Phone

(725) 246-1483

Fax

(702) 440-8430

NPI assigned

Apr 23, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Wanda Marie Wilkins

Title

Credentialing

Phone

(206) 755-1879

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Nevada Mental Health Other name

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

{
    "created_epoch": "1619136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633046400000",
    "number": "1699357111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 S RANCHO DR STE 4-903",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891063837",
            "telephone_number": "702-440-8840"
        },
        {
            "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": "725-246-1483",
            "fax_number": "702-440-8430"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6600 W Charleston Blvd Ste 140",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891461067",
            "country_code": "US",
            "telephone_number": "702-440-8430",
            "fax_number": "866-518-0781",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "840 S Rancho Dr Ste 4-903",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891063837",
            "country_code": "US",
            "telephone_number": "702-440-8840",
            "fax_number": "866-518-0781",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STARK MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-23",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A",
        "authorized_official_last_name": "WILKINS",
        "authorized_official_first_name": "WANDA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "206-755-1879",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "832602698",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902149248",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nevada Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nevada Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nevada Mental Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Starcare LLC
• Lauri R Staretz
• Starfield Emergency Physicians, PPLC
• Starfruit Holdings, LLC (Trellis Paradise)
• Stark Industries Medical
• Stark Medicine Khurana Jeider PLLC (Nevada Mental Health)
• Stark Medicine Khurana Jeider PLLC (Nevada Mental Health)
• Beatrice Ann Stark, D.D.S.
• Brian William Stark Jr., PA-C
• Ellen Stark, LSW

• Mental Health Clinic/Center (Including Community Mental Health Center) in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 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.