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NPI Code Detail

MEDICARE: KORRIN TAYLOR KELLY

MEDICARE: KORRIN TAYLOR KELLY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1124465554
Entity Type Code : Individual
Provider Name (Legal Business Name) : KORRIN TAYLOR KELLY
Provider Business Mailing Address
First Line : PO BOX 458
Second Line :
City : LOGANDALE
State : NV
Zip : 89021-0458
Country : US
Telephone Number : 702-624-0499
Fax Number :
Provider Business Practice Location Address
First Line : 11500 S EASTERN AVE STE 150
Second Line :
City : HENDERSON
State : NV
Zip : 89052-5576
Country : US
Telephone Number : 702-624-0499
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2013
Last Update Date : 03/27/2025

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Directions to “ KORRIN TAYLOR KELLY ” Practice Location

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