Provider Demographics
NPI:1194603514
Name:SOUTHWEST PRESTIGE PEDIATRICS & AESTHETICS
Entity type:Organization
Organization Name:SOUTHWEST PRESTIGE PEDIATRICS & AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:702-508-3040
Mailing Address - Street 1:8370 COZUMEL CREEK CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4689
Mailing Address - Country:US
Mailing Address - Phone:276-690-6177
Mailing Address - Fax:
Practice Address - Street 1:9475 S RAINBOW BLVD
Practice Address - Street 2:SUITE B120, STUDIO 11
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139
Practice Address - Country:US
Practice Address - Phone:702-508-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty