Provider Demographics
NPI:1871752303
Name:D'AGOSTINO, MEREDITH NETTLES (DNP, PMHNP, CPNP)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:NETTLES
Last Name:D'AGOSTINO
Suffix:
Gender:F
Credentials:DNP, PMHNP, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N RAINBOW BLVD STE 300-345
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1082
Mailing Address - Country:US
Mailing Address - Phone:833-246-8353
Mailing Address - Fax:
Practice Address - Street 1:500 N RAINBOW BLVD STE 300-345
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1082
Practice Address - Country:US
Practice Address - Phone:833-246-8353
Practice Address - Fax:844-750-6902
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3584363LP0200X, 363LP0808X
NV816203363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1367Medicaid
SC3584-APRNOtherMEDICAL LICENSE
NV816203OtherNV APRN LICENSE