Provider Demographics
NPI:1750961173
Name:PHILLIPS, KELLIE LEANNE (RN)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:LEANNE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:KELLIE
Other - Middle Name:LEANNE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN50420
Mailing Address - Street 1:3001 SAINT ROSE PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3839
Mailing Address - Country:US
Mailing Address - Phone:702-616-5600
Mailing Address - Fax:
Practice Address - Street 1:3001 SAINT ROSE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3839
Practice Address - Country:US
Practice Address - Phone:702-616-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN50421163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRN50420OtherLISCENSE NUMBEE