Individual
SHARON L KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CP
Contact information
Practice address
20 AFFONSO DR, CARSON CITY, NV 89706-7815
(800) 858-7276
Mailing address
20 AFFONSO DR, CARSON CITY, NV 89706-7815
(800) 858-7276
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
474708752
—
NV
Enumeration date
06/27/2019
Last updated
06/27/2019
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