Provider Demographics
NPI:1699053660
Name:WADSWORTH, ADELBERT SCOTT (PA-C)
Entity type:Individual
Prefix:
First Name:ADELBERT
Middle Name:SCOTT
Last Name:WADSWORTH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 W SUNSET RD STE 201A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1981
Mailing Address - Country:US
Mailing Address - Phone:702-385-4342
Mailing Address - Fax:
Practice Address - Street 1:7500 SMOKE RANCH RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0373
Practice Address - Country:US
Practice Address - Phone:702-233-0727
Practice Address - Fax:702-442-1886
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV107167Medicare UPIN
NVE93416Medicare UPIN