Individual ProviderEric SturdivantNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address501 S. Rancho Drive, Suite I-61, Las Vegas, NV 89106(888) 749-6325PECOS EnrollmentBased on the most recent information from CMS, provider Eric Sturdivant does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1801056304Provider TypeIndividualFull NameSturdivant, EricTitleMr.CredentialMD, APRN, FNP-CGenderMaleSole ProprietorYesEnumeration Date6/10/2008Last Updated9/20/2021Contact InformationPractice LocationPractice Address501 S. Rancho Drive, Suite I-61, Las Vegas, NV 89106Phone(888) 749-6325Fax(702) 441-1969Mailing LocationMailing Address3824 Cedar Springs Rd Unit 274, Dallas, TX 75219-4136Phone(888) 749-6325Fax(702) 441-1969Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense837695NevadaCode363LF0000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense1026677Texas