Healthcare Provider Details

I. General information

NPI: 1912536475
Provider Name (Legal Business Name): MELISSA MARIE KERKELIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E 2ND ST STE 206
RENO NV
89502-1198
US

IV. Provider business mailing address

1155 MILL ST # M-14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-3866
  • Fax: 775-982-3868
Mailing address:
  • Phone: 775-982-3866
  • Fax: 775-982-3868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number29702
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number73872
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number73872
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29702
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: