Jennifer Russo, RN, PMHNP
Nurse Practitioner, Psych/Mental Health in Las Vegas, NV. Individual provider (NPI-1).
Details
- NPI
- 1407200413
- Entity type
- Individual (NPI-1)
- Name
- Jennifer Russo
- Credential
- RN, PMHNP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 15, 2016
- Certification date
- Oct 31, 2024
- Last updated
- Oct 31, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - NURSE PRACTITIONER
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | 202203390-NP-PP | OR | Yes |
| 174H00000X | Health Educator | RN55131 | NV | |
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | G167246 | IA | |
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | 238538 | AZ | |
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | 848206 | NV |
Practice location
2480 E Tompkins Ave Ste 100Las Vegas, NV 89121-7394
Phone 725-724-2005 · Fax 877-418-8013
Mailing address
83 Kind AveHenderson, NV 89002-3364
Phone 702-824-7691
Other practice locations
Henderson, NV 89002-3364
Phone 702-824-7691
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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