Identity Hormones NV LLC

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

Legal business name

IDENTITY HORMONES NV LLC

Practice address

1701 N Green Valley Pkwy Ste F
Henderson, NV 89074-5885

Phone

(702) 661-3438

NPI assigned

Mar 4, 2024

Organization subpart

No

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

Authorized official

Name

Amanda Wilkinson

Title

Business Operations Director

Phone

(602) 796-2559

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1709510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739923200000",
    "number": "1780441998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 N GREEN VALLEY PKWY STE F",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890745885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 N GREEN VALLEY PKWY STE F",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890745885",
            "telephone_number": "702-661-3438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDENTITY HORMONES NV LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-04",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "BUSINESS OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "602-796-2559"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; 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.