MEDICARE: G TIMOTHY KELLY

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	174400000X	Specialist

General Provider Information

NPI Number	:	1609749498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G TIMOTHY KELLY

Provider Business Mailing Address
First Line	:	7200 CATHEDRAL ROCK DR STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0439
Country	:	US
Telephone Number	:	702-341-5444
Fax Number	:	702-341-5445

Provider Business Practice Location Address
First Line	:	7200 CATHEDRAL ROCK DR STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0439
Country	:	US
Telephone Number	:	702-341-5444
Fax Number	:	702-341-5445

Authorized Official
Title or Position	:	OWNER
Name	:	G TIMOTHY KELLY
Credential	:	MD
Telephone Number	:	702-341-5444

Provider Enumeration Date	:	09/26/2025
Last Update Date	:	09/26/2025

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Directions to “G TIMOTHY KELLY ” Practice Location

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