MEDICARE: KAITLYN JOYCE MCENTEE

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1295527901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN JOYCE MCENTEE

Provider Business Mailing Address
First Line	:	3035 S MARYLAND PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5409 E LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-6709
Country	:	US
Telephone Number	:	702-857-8800
Fax Number	:

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

Provider Enumeration Date	:	05/19/2025
Last Update Date	:	05/19/2025

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