Provider Demographics
NPI:1891319398
Name:KELLEY, JORDAN RAY (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:RAY
Last Name:KELLEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 EMERALD VISTA WAY UNIT 167
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4145
Mailing Address - Country:US
Mailing Address - Phone:702-720-5265
Mailing Address - Fax:702-996-4458
Practice Address - Street 1:220 EMERALD VISTA WAY UNIT 167
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-4145
Practice Address - Country:US
Practice Address - Phone:702-720-5265
Practice Address - Fax:702-996-4458
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2023-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV826262367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered