Provider Demographics
NPI:1588051213
Name:BOURKE, MELANIE R (RN, PMHNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:R
Last Name:BOURKE
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8285 W ARBY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2236
Mailing Address - Country:US
Mailing Address - Phone:725-212-4523
Mailing Address - Fax:725-212-4524
Practice Address - Street 1:8285 W ARBY AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2236
Practice Address - Country:US
Practice Address - Phone:725-212-4523
Practice Address - Fax:725-212-4524
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV857793363LP0808X, 363LF0000X
MNR 218003-8163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse