Provider Demographics
NPI:1962874800
Name:BLIGHT, ALYSON
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:BLIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 MCDANIEL ST STE 210
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-6309
Mailing Address - Country:US
Mailing Address - Phone:702-633-0207
Mailing Address - Fax:702-633-5099
Practice Address - Street 1:5440 W SAHARA AVE
Practice Address - Street 2:#302
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0354
Practice Address - Country:US
Practice Address - Phone:702-633-0207
Practice Address - Fax:702-633-0254
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1962874800Medicaid
NV1962874800Medicaid