Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | NV |
NPI | 1326670779 |
---|---|
Provider Name | Kylie Kelly |
First Address | Sparks, NV 89436-6712 |
Second Address | Sparks, NV 89436-6712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2020 |
Last Update Date | 04/02/2020 |