| Hailstone Family Practice Pllc | |
|
9065 S Pecos Rd Ste 190 Henderson NV 89074-6605 | |
| (725) 485-2080 | |
| (885) 576-5067 |
| Full Name | Hailstone Family Practice Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 9065 S Pecos Rd Ste 190, Henderson, Nevada |
| Authorized Official Name and Position | Travis Hailstone (OWNER/PHYSICIAN) |
| Authorized Official Contact | 7254852080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hailstone Family Practice Pllc 9065 S Pecos Road Suite 190 Henderson NV 89074-4539 Ph: (725) 485-2080 | Hailstone Family Practice Pllc 9065 S Pecos Rd Ste 190 Henderson NV 89074-6605 Ph: (725) 485-2080 |
| NPI Number | 1437967320 |
|---|---|
| Provider Enumeration Date | 12/23/2024 |
| Last Update Date | 02/03/2025 |
| Medicare PECOS PAC ID | 5092243238 |
|---|---|
| Medicare Enrollment ID | O20250115002074 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437967320 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Travis G Hailstone |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215165238 PECOS PAC ID: 0840448999 Enrollment ID: I20120913000684 |
| Provider Name | Deokchol Parish |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841885142 PECOS PAC ID: 0042611196 Enrollment ID: I20210625002097 |
| Provider Name | Reyna Rosario Dominguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336904416 PECOS PAC ID: 1355870130 Enrollment ID: I20250123001016 |
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