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PROVENANCE HEALTHCARE LLC
NPI 1316322738
Genetic Counselor, MS in Las Vegas, NV

Active since July 27, 2015
5155 S DURANGO DR STE 103, LAS VEGAS, NV 89113(702) 478-2524(702) 735-9074 Get Directions Write a Review

NPPES record last updated: July 27, 2015. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Provenance Healthcare Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVENANCE HEALTHCARE LLC (NPI 1316322738) is a healthcare organization registered as a genetic counselor, ms in Las Vegas, Nevada and active in the NPI registry since July 2015. The organization lists Mark L Black, Owner Operator, as its authorized official.

NPPES Registry Identity

NPI1316322738
Entity TypeOrganization
Primary Taxonomy170300000X
Legal Business NamePROVENANCE HEALTHCARE LLC
Location Address5155 S DURANGO DR STE 103Las Vegas, NV 89113-0175
Mailing Address5155 S Durango Dr Ste 103Las Vegas, NV 89113-0175 · (702) 478-2524 · Fax (702) 735-9074
Phone(702) 478-2524
Fax(702) 735-9074
Organization SubpartNo
Authorized OfficialMark L BlackOwner Operator · (702) 478-2524
Enumeration DateJuly 27, 2015
✔ NPI 1316322738 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGenetic Counselor, MSOther Service Providers
Taxonomy Code170300000X
License✔ Licensed in NV · OTHER
Definition
A masters trained health care provider who collects and interprets genetic family histories; assesses the risk of disease occurrence or recurrence; identifies interventions to manage or ameliorate disease risk; educates about inheritance, testing, management, prevention, ethical issues, resources, and research; and counsels to promote informed choices and adaptation. Certification was established in 1993 by the American Board of Genetic Counseling and prior to that by the American Board of Medical Genetics. Requirements for experience, licensure, and job responsibilities vary among the states.
5155 S DURANGO DR STE 103, Las Vegas, NV 89113
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Provenance Healthcare LLC's NPI number?

The NPI number for Provenance Healthcare LLC is 1316322738. It was assigned to this organization in the NPPES registry on July 27, 2015.

Where is Provenance Healthcare LLC located?

Provenance Healthcare LLC is located at 5155 S Durango Dr Ste 103, Las Vegas, NV 89113. The listed phone number is (702) 478-2524.

What is Provenance Healthcare LLC's specialty?

The primary specialty registered for this NPI is Genetic Counselor, MS with taxonomy code 170300000X.

When was this NPI record last updated?

The NPPES record for Provenance Healthcare LLC was last updated on July 27, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.