Healthcare Provider Details

I. General information

NPI: 1053929463
Provider Name (Legal Business Name): ARIANNA BROOKE KILLEBREW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10395 DOUBLE R BLVD
RENO NV
89521-5991
US

IV. Provider business mailing address

12003 ROCKY MOUNTAIN ST
RENO NV
89506-1557
US

V. Phone/Fax

Practice location:
  • Phone: 775-507-2606
  • Fax:
Mailing address:
  • Phone: 775-842-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11764-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: