Provider Demographics
NPI:1376825075
Name:GAFFORD, KELLY PATRICE
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:PATRICE
Last Name:GAFFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7641 LANI DAWN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-1605
Mailing Address - Country:US
Mailing Address - Phone:702-326-9779
Mailing Address - Fax:
Practice Address - Street 1:7641 LANI DAWN ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-1605
Practice Address - Country:US
Practice Address - Phone:702-326-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst