MEDICARE: MR. JOHN P KELLY MD

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	207RX0202X	Medical Oncology Physician	6376	NV
2	207RH0003X	Hematology & Oncology Physician	NV6376	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6376	OTHER	NV	MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477512234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN P KELLY MD

Provider Business Mailing Address
First Line	:	PO BOX 4540
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89702-4540
Country	:	US
Telephone Number	:	775-882-0430
Fax Number	:	775-852-6902

Provider Business Practice Location Address
First Line	:	1535 MEDICAL PKWY
Second Line	:	STE B
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4654
Country	:	US
Telephone Number	:	775-445-7960
Fax Number	:	775-883-3395

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	09/18/2014

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Directions to “ MR. JOHN P KELLY MD” Practice Location

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