MEDICARE: RHONDA DENISE 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	101YM0800X	Mental Health Counselor
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1275022808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA DENISE KELLY

Provider Business Mailing Address
First Line	:	328 GEMSTONE HILL AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-6862
Country	:	US
Telephone Number	:	310-921-0579
Fax Number	:

Provider Business Practice Location Address
First Line	:	328 GEMSTONE HILL AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-6862
Country	:	US
Telephone Number	:	310-921-0579
Fax Number	:

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

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	11/19/2021

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Directions to “ RHONDA DENISE KELLY ” Practice Location

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