Individual ProviderStanley KidiavayiNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address801 S Rancho Dr Ste B1b, Las Vegas, NV 89106-3871(702) 490-2398PECOS EnrollmentBased on the most recent information from CMS, provider Stanley Kidiavayi is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1902290968Provider TypeIndividualFull NameKidiavayi, StanleyCredentialAPRNGenderMaleSole ProprietorNoEnumeration Date3/26/2015Last Updated1/26/2023Contact InformationPractice LocationPractice Address801 S Rancho Dr Ste B1b, Las Vegas, NV 89106-3871Phone(702) 490-2398Fax(702) 912-2273Mailing LocationMailing Address801 S Rancho Dr Ste B1b, Las Vegas, NV 89106-3871Phone(702) 490-2398Fax(702) 912-2273Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseAPRN002072NevadaCode363LP0808XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseAPRN002072Nevada