MEDICARE: ASHLEY KELLY

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	222Q00000X	Developmental Therapist
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1235567579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY KELLY

Provider Business Mailing Address
First Line	:	7374 W. LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-608-7290
Fax Number	:	702-522-6075

Provider Business Practice Location Address
First Line	:	7310 SMOKE RANCH RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0258
Country	:	US
Telephone Number	:	702-608-7290
Fax Number	:	702-522-6075

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

Provider Enumeration Date	:	10/24/2013
Last Update Date	:	03/31/2023

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Directions to “ ASHLEY KELLY ” Practice Location

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