MEDICARE: ASHLEY V KELLEY M.D.

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
1	207R00000X	Internal Medicine Physician	9041	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CS09666	OTHER	NV	PHARMACY LICENSE
2	9041	OTHER	NV	NV STATE LICENSE

General Provider Information

NPI Number	:	1205929320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY V KELLEY M.D.

Provider Business Mailing Address
First Line	:	2701 N TENAYA WAY STE 240
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0480
Country	:	US
Telephone Number	:	702-463-3008
Fax Number	:	580-223-2397

Provider Business Practice Location Address
First Line	:	2701 N TENAYA WAY STE 240
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0480
Country	:	US
Telephone Number	:	702-666-6878
Fax Number	:	702-666-6879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/07/2023

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