Basic Information
Provider Information
NPI: 1912406687
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KIELION
FirstName: PATRICIA
MiddleName: ROXANNE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1327 H ST APT 110
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891062976
CountryCode: US
TelephoneNumber: 7026809926
FaxNumber:  
Practice Location
Address1: 1700 E DESERT INN RD
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891693242
CountryCode: US
TelephoneNumber: 7028391088
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/07/2018
LastUpdateDate: 02/07/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
3747P1801X  Y Nursing Service Related ProvidersTechnicianPersonal Care Attendant

No ID Information.


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