MEDICARE: MRS. KELIN BAEZ APRN

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	363L00000X	Nurse Practitioner	828628	NV

General Provider Information

NPI Number	:	1568086734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELIN BAEZ APRN

Provider Business Mailing Address
First Line	:	9659 POWELL RIVER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1789
Country	:	US
Telephone Number	:	702-334-6773
Fax Number	:

Provider Business Practice Location Address
First Line	:	3730 LAS VEGAS BLVD S
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89158-4300
Country	:	US
Telephone Number	:	702-590-9607
Fax Number	:

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

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	06/03/2020

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