MEDICARE: ASHLEY V KELLEY MD PC

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	207R00000X	Internal Medicine Physician	9041	NV

General Provider Information

NPI Number	:	1134538259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHLEY V KELLEY MD PC

Provider Business Mailing Address
First Line	:	9811 W CHARLESTON BLVD
Second Line	:	SUITE 2-512
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9811 W CHARLESTON BLVD
Second Line	:	SUITE 2-512
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7528
Country	:	US
Telephone Number	:	405-702-2259
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLEY KELLEY
Credential	:	MD
Telephone Number	:	405-702-2259

Provider Enumeration Date	:	08/04/2014
Last Update Date	:	08/04/2014

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