MEDICARE: KELLY JEANNE NOEL PA

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	363A00000X	Physician Assistant	PA1164	NV

General Provider Information

NPI Number	:	1588807978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY JEANNE NOEL PA

Provider Business Mailing Address
First Line	:	7140 SMOKE RANCH RD STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3157
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3175 SAINT ROSE PKWY STE 121
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-3507
Country	:	US
Telephone Number	:	702-320-8111
Fax Number	:

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

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	08/06/2025

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