MEDICARE: JARED W KELLEY

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	374U00000X	Home Health Aide		NV

General Provider Information

NPI Number	:	1780167627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED W KELLEY

Provider Business Mailing Address
First Line	:	4140 E CINCINNATI AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5210
Country	:	US
Telephone Number	:	702-812-7690
Fax Number	:

Provider Business Practice Location Address
First Line	:	4140 E CINCINNATI AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5210
Country	:	US
Telephone Number	:	702-812-7690
Fax Number	:

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

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	09/06/2018

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Directions to “ JARED W KELLEY ” Practice Location

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