Provider Demographics
NPI:1275698284
Name:KURTZ, KELLY LEIGH (ARNP-C)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LEIGH
Last Name:KURTZ
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:
Practice Address - Street 1:1372 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3203
Practice Address - Country:US
Practice Address - Phone:470-964-1700
Practice Address - Fax:678-288-5639
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV834163363L00000X
NY308061363LA2200X
CA95010236363LA2200X
GARN308026363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1275698284OtherNPI
FL0019761000Medicaid
FLY03N2OtherBLUE CROSS BLUE SHIELD
FL0019761000Medicaid
1275698284OtherNPI