Provider Demographics
NPI:1578544581
Name:WOODS, KELLEY JANE (DPM)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:JANE
Last Name:WOODS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 SO. JONES BLVD #6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-7121
Mailing Address - Country:US
Mailing Address - Phone:702-354-2452
Mailing Address - Fax:
Practice Address - Street 1:3815 S JONES BLVD
Practice Address - Street 2:3815 SO JONES BLVD #6
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2289
Practice Address - Country:US
Practice Address - Phone:702-354-2452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV9905213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV8842OtherBLUE CROSS NUMBER
NV5384790001Medicare NSC
NV8842OtherBLUE CROSS NUMBER
NVU76967Medicare UPIN