Provider Demographics
NPI:1205929320
Name:KELLEY, ASHLEY V (MD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:V
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 N TENAYA WAY STE 240
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0480
Mailing Address - Country:US
Mailing Address - Phone:702-463-3008
Mailing Address - Fax:580-223-2397
Practice Address - Street 1:2701 N TENAYA WAY STE 240
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0480
Practice Address - Country:US
Practice Address - Phone:702-666-6878
Practice Address - Fax:702-666-6879
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9041207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS09666OtherPHARMACY LICENSE
NV9041OtherNV STATE LICENSE
NV9041OtherNV STATE LICENSE