Provider Demographics
NPI:1396041679
Name:LAWRENCE, KELLY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MICHAEL
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4700 LAS VEGAS BLVD N
Mailing Address - Street 2:
Mailing Address - City:NELLIS AFB
Mailing Address - State:NV
Mailing Address - Zip Code:89191-6600
Mailing Address - Country:US
Mailing Address - Phone:702-653-3800
Mailing Address - Fax:702-653-3253
Practice Address - Street 1:235 W 6TH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503
Practice Address - Country:US
Practice Address - Phone:775-770-6490
Practice Address - Fax:775-770-3944
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.120908207R00000X
NV17990207R00000X, 208M00000X
SC84718207R00000X, 208M00000X
KS04-45853207R00000X, 208M00000X
WAMD60615589208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine