Provider Demographics
NPI:1487684189
Name:KELLY, PARDIS A (DPM)
Entity type:Individual
Prefix:DR
First Name:PARDIS
Middle Name:A
Last Name:KELLY
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Gender:F
Credentials:DPM
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Mailing Address - Street 1:8550 W CHARLESTON BLVD
Mailing Address - Street 2:STE 102 PMB 396
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5000
Mailing Address - Country:US
Mailing Address - Phone:650-303-5100
Mailing Address - Fax:650-595-3013
Practice Address - Street 1:9940 W FLAMINGO ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147
Practice Address - Country:US
Practice Address - Phone:702-605-6220
Practice Address - Fax:702-605-5880
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-02-15
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Provider Licenses
StateLicense IDTaxonomies
CAE41580213E00000X
NV2063213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E41580Medicare ID - Type Unspecified
CA5446830001Medicare NSC