Healthcare Provider Details

I. General information

NPI: 1164276978
Provider Name (Legal Business Name): KELSEY LANDIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W HORIZON RIDGE PKWY STE 121
HENDERSON NV
89052-5014
US

IV. Provider business mailing address

196 VINE CLIFF AVE
HENDERSON NV
89002-3388
US

V. Phone/Fax

Practice location:
  • Phone: 702-531-8933
  • Fax:
Mailing address:
  • Phone: 702-635-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN88623
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: