Healthcare Provider Details

I. General information

NPI: 1669826913
Provider Name (Legal Business Name): KACI DUDLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2386
US

IV. Provider business mailing address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2386
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-2648
  • Fax: 702-383-2627
Mailing address:
  • Phone: 702-383-2620
  • Fax: 702-383-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberA158974
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA158974
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28223
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA158974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: