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Individual

KYLE J KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
APRN

Contact information

Practice address
360 S LOLA LN, PAHRUMP, NV 89048-0884
(775) 751-7500
Mailing address
1918 SE 6TH AVE, CAMAS, WA 98607-2204
(702) 328-3186

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
202004792NP-PP
OR
363LF0000X
Family Nurse Practitioner
826511
NV

Other

Enumeration date
12/27/2019
Last updated
12/31/2021
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