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NPI Code Detail

MEDICARE: KELLEY DEGROAT

MEDICARE: KELLEY DEGROAT
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1629244843
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLEY DEGROAT
Provider Business Mailing Address
First Line : 6161 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-1126
Country : US
Telephone Number : 702-486-6000
Fax Number :
Provider Business Practice Location Address
First Line : 1785 E SAHARA AVE STE 145
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-3713
Country : US
Telephone Number : 702-486-6098
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2008
Last Update Date : 05/07/2008

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Directions to “ KELLEY DEGROAT ” Practice Location

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