Provider Demographics
NPI:1497209928
Name:FINK, KELLY LYNORE
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNORE
Last Name:FINK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNORE
Other - Last Name:ROSENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2031 NORTH BUFFALO DR.
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-383-2650
Mailing Address - Fax:702-256-2213
Practice Address - Street 1:2031 NORTH BUFFALO DR.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-383-2650
Practice Address - Fax:702-256-2213
Is Sole Proprietor?:No
Enumeration Date:2016-08-13
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN59619163W00000X
NVAPRN002358363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse