Individual
KELLEY NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4455 S PECOS RD STE C, LAS VEGAS, NV 89121-5029
(702) 350-1430
Mailing address
4000 E CHARLESTON BLVD, #B230, LAS VEGAS, NV 89104-6659
(702) 968-4000
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6849-C
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336320555
—
NV
Enumeration date
11/15/2007
Last updated
05/07/2019
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