Provider Demographics
NPI:1003557273
Name:MCCORKLE, RAEGAN (FNP)
Entity type:Individual
Prefix:MRS
First Name:RAEGAN
Middle Name:
Last Name:MCCORKLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 E LAKE MEAD BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7190
Mailing Address - Country:US
Mailing Address - Phone:702-818-1919
Mailing Address - Fax:702-399-5499
Practice Address - Street 1:1815 E LAKE MEAD BLVD STE 215
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7190
Practice Address - Country:US
Practice Address - Phone:702-818-1919
Practice Address - Fax:702-399-5499
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-04
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV852529207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine