Healthcare Provider Details

I. General information

NPI: 1497020531
Provider Name (Legal Business Name): KELLEY ANNE QUATTRO BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 SHADOW LN
LAS VEGAS NV
89102-2342
US

IV. Provider business mailing address

2121 W CHARLESTON BLVD
LAS VEGAS NV
89102-2205
US

V. Phone/Fax

Practice location:
  • Phone: 725-726-2535
  • Fax: 725-237-9661
Mailing address:
  • Phone: 702-382-7746
  • Fax: 725-237-9661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number06815-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: