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General NPI Number Information
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NPI Number | 1326687120
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Entity Type | Individual
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Provider Name | KYLE J KELLY APRN
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Gender | Male
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Dates
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Enumeration Date | 12/27/2019
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Last Update Date | 12/31/2021
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Provider Practice Location Address
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Address Line | 360 S LOLA LN
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City | PAHRUMP
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State | NV
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Zip | 89048-0884
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Country | US
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Telephone | 775-751-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 1918 SE 6TH AVE
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City | CAMAS
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State | WA
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Zip | 98607-2204
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Country | US
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Telephone | 702-328-3186
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 202004792NP-PP
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 826511
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License Number State | NV
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