MEDICARE: JULIE KINCHELOE CRT

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	2278P1005X	Pulmonary Rehabilitation Certified Respiratory Therapist	RC1051	NV

General Provider Information

NPI Number	:	1285844258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE KINCHELOE CRT

Provider Business Mailing Address
First Line	:	5316 EL DORADO WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-1792
Country	:	US
Telephone Number	:	702-641-5757
Fax Number	:	702-641-5757

Provider Business Practice Location Address
First Line	:	1655 W. HORIZON RIDGE PARKWAY
Second Line	:	SUITE 100
City	:	HENDERSON
State	:	NV
Zip	:	89012-0000
Country	:	US
Telephone Number	:	702-914-2790
Fax Number	:	702-914-5984

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	10/26/2010

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