South Valley Pediatric Center

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

APN000878 Issued in NV

Legal business name

SOUTH VALLEY PEDIATRIC CENTER

Practice address

2610 W Horizon Ridge Pkwy
Suite 200
Henderson, NV 89052-2869

Phone

(702) 492-0004

Fax

(702) 492-0006

NPI assigned

May 29, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Gale Lynn Koch

Title

Owner

Phone

(702) 492-0004

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740481837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2610 W HORIZON RIDGE PKWY",
            "address_2": "SUITE 200",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890522869",
            "telephone_number": "702-492-0004",
            "fax_number": "702-492-0006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2610 W HORIZON RIDGE PKWY",
            "address_2": "SUITE 200",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890522869",
            "telephone_number": "702-492-0004",
            "fax_number": "702-492-0006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH VALLEY PEDIATRIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOCH",
        "authorized_official_first_name": "GALE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-492-0004",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NV",
            "license": "APN000878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Nurse Practitioner in Henderson, NV
• Providers in Henderson, NV by specialty
• Pediatric Nurse Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.