Healthcare Provider Details

I. General information

NPI: 1023393055
Provider Name (Legal Business Name): SCHALEY KATHLEEN ALLEN RT(R)(CT)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RANCHO LN
LAS VEGAS NV
89106-3836
US

IV. Provider business mailing address

31A MCCARRAN BLVD
LAS VEGAS NV
89115-2678
US

V. Phone/Fax

Practice location:
  • Phone: 702-636-3000
  • Fax:
Mailing address:
  • Phone: 903-293-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number95857
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number95857
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: