MEDICARE: DR. KELLEY JANE WOODS D.P.M

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	213E00000X	Podiatrist	NV9905	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8842	OTHER	NV	BLUE CROSS NUMBER

General Provider Information

NPI Number	:	1578544581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLEY JANE WOODS D.P.M

Provider Business Mailing Address
First Line	:	3815 SO. JONES BLVD #6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-7121
Country	:	US
Telephone Number	:	702-354-2452
Fax Number	:

Provider Business Practice Location Address
First Line	:	3815 S JONES BLVD
Second Line	:	3815 SO JONES BLVD #6
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2289
Country	:	US
Telephone Number	:	702-354-2452
Fax Number	:

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	11/27/2007

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