Provider Demographics
NPI:1841466810
Name:PALAKANIS, KERRY COLLEEN (CRNP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:COLLEEN
Last Name:PALAKANIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:COLLEEN
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:2820 ARAGON TERRACE WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-1686
Mailing Address - Country:US
Mailing Address - Phone:385-707-7175
Mailing Address - Fax:
Practice Address - Street 1:10120 S EASTERN AVE STE 130
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3953
Practice Address - Country:US
Practice Address - Phone:385-707-7175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR105366363LF0000X
NVAPN001102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD855810800Medicaid
MD855810800Medicaid