De' Andre Kelly
Technician, Attendant Care Provider in Las Vegas, NV. Individual provider (NPI-1).
NPI number1164084547
StatusActive
Last updated in NPPESJul 5, 2019
Details
- NPI
- 1164084547
- Entity type
- Individual (NPI-1)
- Name
- De' Andre Kelly
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 5, 2019
- Last updated
- Jul 5, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3747A0650X | Technician, Attendant Care Provider | – | – | Yes |
Practice location
3070 S Nellis Blvd Apt 3189Las Vegas, NV 89121-2057
Phone 725-222-7203
Mailing address
2110 E Flamingo RdLas Vegas, NV 89119-5190
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