Provider Demographics
NPI:1700076460
Name:FLUITT, KELLY JO (APN)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JO
Last Name:FLUITT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JO
Other - Last Name:DORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 MOUNTAIN ST STE 230
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-3867
Mailing Address - Country:US
Mailing Address - Phone:775-882-1323
Mailing Address - Fax:
Practice Address - Street 1:1200 MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3821
Practice Address - Country:US
Practice Address - Phone:775-882-1324
Practice Address - Fax:775-882-2382
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN000956363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner