Provider Demographics
NPI:1780973354
Name:CHEVALLIER, KEELY (MD)
Entity type:Individual
Prefix:DR
First Name:KEELY
Middle Name:
Last Name:CHEVALLIER
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 1:9770 S MCCARRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-9203
Mailing Address - Country:US
Mailing Address - Phone:775-322-4589
Mailing Address - Fax:
Practice Address - Street 1:9770 S MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-9203
Practice Address - Country:US
Practice Address - Phone:775-322-4589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19794207Y00000X
UT8405870207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology