Kelli Nissen

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

867835 Issued in NV

Practice address

7730 W Cheyenne Ave Ste 107
Las Vegas, NV 89129-8412

Phone

(725) 333-9218

Fax

(833) 485-4980

NPI assigned

May 22, 2023

Last updated

Mar 15, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Haraway Medical Group PLLCGroup PAC ID 4587990619, 4 clinicians

Malone-Davis Neurology PLLCGroup PAC ID 4880968734, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EFABBD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Malone-Davis Neurology PLLC

  • Neurology Physician
  • Las Vegas, NV
  • NPI 1932622750
  Medicare reassignment Care Compare group NPD
• Haraway Medical Group PLLC

  dba Red Rock Neurology & Pain Management

  • Pain Medicine (Psychiatry & Neurology) Physician
  • North Las Vegas, NV
  • NPI 1104482595
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1684713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773532800000",
    "number": "1952093692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7730 W CHEYENNE AVE STE 107",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891298412",
            "fax_number": "833-485-4980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7730 W CHEYENNE AVE STE 107",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891298412",
            "telephone_number": "725-333-9218",
            "fax_number": "833-485-4980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSEN",
        "first_name": "KELLI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-22",
        "last_updated": "2026-03-15",
        "certification_date": "2026-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NV",
            "license": "867835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jaylene Nisihura
• Niswonger Psychological Health, LLC
• Jodi Niswonger, L.C.S.W.
• Nita Kaul MD PC20
• Nitai Anesthesia Group PLLC
• Malinie Nitivong

• Gerontology Nurse Practitioner in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Gerontology Nurse Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.