MEDICARE: KELLI M GANDY APRN-PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	860001	NV
2	163W00000X	Registered Nurse	RN71632	NV

General Provider Information

NPI Number	:	1124790126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI M GANDY APRN-PMHNP

Provider Business Mailing Address
First Line	:	5510 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7700
Country	:	US
Telephone Number	:	725-525-7166
Fax Number	:

Provider Business Practice Location Address
First Line	:	5510 S FORT APACHE RD STE 450
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7700
Country	:	US
Telephone Number	:	725-525-7166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2021
Last Update Date	:	03/04/2026

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