Provider Demographics
NPI:1538703384
Name:KILMALEY
Entity Type:Organization
Organization Name:KILMALEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BRIDGET
Authorized Official - Last Name:HUNTLY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:702-374-3304
Mailing Address - Street 1:7975 W SAHARA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7916
Mailing Address - Country:US
Mailing Address - Phone:725-205-2547
Mailing Address - Fax:725-240-7742
Practice Address - Street 1:7975 W SAHARA AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7916
Practice Address - Country:US
Practice Address - Phone:725-205-2547
Practice Address - Fax:725-240-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1760952360OtherINDIVIDUAL NPI