Provider Demographics
NPI:1710395496
Name:TWELLS, KELLY YOVANNO (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:YOVANNO
Last Name:TWELLS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 W LAKE MEAD PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7417
Mailing Address - Country:US
Mailing Address - Phone:725-220-8477
Mailing Address - Fax:833-749-0360
Practice Address - Street 1:390 W LAKE MEAD PKWY STE 120
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7417
Practice Address - Country:US
Practice Address - Phone:252-208-4777
Practice Address - Fax:833-749-0360
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1710395496Medicaid
NVV74329OtherMEDICARE
NV1710395496Medicaid