MEDICARE: KELLY J LAU FNP-BC

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	363LF0000X	Family Nurse Practitioner	APN00483	NE

General Provider Information

NPI Number	:	1902983331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY J LAU FNP-BC

Provider Business Mailing Address
First Line	:	2100 E CALVADA BLVD
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-5805
Country	:	US
Telephone Number	:	702-526-1776
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 E CALVADA BLVD
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-5805
Country	:	US
Telephone Number	:	702-526-1776
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	03/07/2023

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