MEDICARE: KELLEY ANNE QUATTRO BA

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
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	06815-C	NV

General Provider Information

NPI Number	:	1497020531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY ANNE QUATTRO BA

Provider Business Mailing Address
First Line	:	2121 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2205
Country	:	US
Telephone Number	:	702-382-7746
Fax Number	:	725-237-9661

Provider Business Practice Location Address
First Line	:	1120 SHADOW LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2342
Country	:	US
Telephone Number	:	725-726-2535
Fax Number	:	725-237-9661

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

Provider Enumeration Date	:	03/21/2012
Last Update Date	:	11/10/2025

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Directions to “ KELLEY ANNE QUATTRO BA” Practice Location

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