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General NPI Number Information
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NPI Number | 1497020531
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Entity Type | Individual
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Provider Name | KELLEY ANNE QUATTRO BA
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Gender | Female
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 1120 SHADOW LN
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City | LAS VEGAS
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State | NV
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Zip | 89102-2342
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Country | US
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Telephone | 725-726-2535
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Fax | 725-237-9661
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Provider Business Mailing Address
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Address Line | 2121 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-2205
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Country | US
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Telephone | 702-382-7746
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Fax | 725-237-9661
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 06815-C
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License Number State | NV
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