MEDICARE: KRISTA BREANN KELLY RN

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	163WH0200X	Home Health Registered Nurse	897037	NV

General Provider Information

NPI Number	:	1902757172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA BREANN KELLY RN

Provider Business Mailing Address
First Line	:	6088 VILLA LANTE AVE STE 400
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1767
Country	:	US
Telephone Number	:	702-201-0904
Fax Number	:

Provider Business Practice Location Address
First Line	:	6088 VILLA LANTE AVE STE 400
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1767
Country	:	US
Telephone Number	:	702-201-0904
Fax Number	:

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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