Individual provider Active NPI

Olivia Fernandez, AGNP-BC

  • Gerontology Nurse Practitioner
  • Las Vegas, NV
National Provider Identifier
1912423682
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
APRN002558 Issued in NV
Practice address
400 Shadow LN Ste 101
Las Vegas, NV 89106-4355
Phone
(702) 382-7760
Fax
(702) 382-7871
NPI assigned
Aug 15, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X APRN002558 NV Primary

Addresses

Primary practice location

400 Shadow LN Ste 101
Las Vegas, NV 89106-4355

Mailing address

6355 S Buffalo Dr FL 3
Las Vegas, NV 89113-2133
Phone (702) 216-3346

Other practice location 1

2865 Siena Heights Dr Ste 331
Henderson, NV 89052-4171
Phone (702) 407-0110

Other identifiers 2

IdentifierTypeStateIssuer
1912423682MedicaidNV
APRN002558OtherNVSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171114001283 NV Practitioner - Nurse Practitioner 6901162619 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2865 Siena Heights Dr
Suite 331
Henderson, NV 89052-4171
Phone (702) 407-0110

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN002558NVMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Holdings Nevada Inc CurrentSince Jan 1, 2022 Accepting new patients
Intermountain Medical Holdings Nevada Inc CurrentSince Jan 1, 2022 Accepting new patients
Healthcare Partners Medical Group Coats LTD Current Accepting new patients

Locations

2865 Siena Heights Dr
Ste 331
Henderson, NV 89052
Phone (702) 407-0110

595 W Lake Mead Pkwy
Henderson, NV 89015
Phone (702) 566-5500

6355 S Buffalo Dr
Fl 3
Las Vegas, NV 89113
Phone (702) 479-4881

400 Shadow Ln
Ste 207
Las Vegas, NV 89106
Phone (702) 382-7760

4880 Wynn Rd
Las Vegas, NV 89103
Phone (702) 382-4554

1397 S Loop Rd
Pahrump, NV 89048
Phone (775) 727-5500

Interoperability endpoints

  • Direct secure messaging: oliviafernandez@hcpnv.allscriptsdirect.net

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692576000000",
    "number": "1912423682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6355 S BUFFALO DR FL 3",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891132133",
            "telephone_number": "702-216-3346",
            "fax_number": "702-671-6883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 SHADOW LN STE 101",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064355",
            "telephone_number": "702-382-7760",
            "fax_number": "702-382-7871"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2865 Siena Heights Dr Ste 331",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890524171",
            "country_code": "US",
            "telephone_number": "702-407-0110",
            "fax_number": "702-407-0133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "OLIVIA",
        "credential": "AGNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-15",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NV",
            "license": "APRN002558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912423682",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "APRN002558",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.