MEDICARE: KELLY STANFIELD

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	207Q00000X	Family Medicine Physician	888721	NV

General Provider Information

NPI Number	:	1871428771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY STANFIELD

Provider Business Mailing Address
First Line	:	306 MARACAS PL
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-5499
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3377 LAS VEGAS BLVD S
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-8910
Country	:	US
Telephone Number	:	702-778-2800
Fax Number	:

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ KELLY STANFIELD ” Practice Location

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