Healthcare Provider Details

I. General information

NPI: 1528552791
Provider Name (Legal Business Name): MISS MELISSA LYNN KEHOE I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 N RAINBOW BLVD STE 360
LAS VEGAS NV
89107-1188
US

IV. Provider business mailing address

777 N RAINBOW BLVD STE 360
LAS VEGAS NV
89107-1188
US

V. Phone/Fax

Practice location:
  • Phone: 702-281-7357
  • Fax: 702-978-6215
Mailing address:
  • Phone: 702-281-7357
  • Fax: 702-978-6215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: