Provider Demographics
NPI:1386617355
Name:MCKELVIE, CAROLYN J (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:MCKELVIE
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 1:3012 S. DURANGO DR.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117
Mailing Address - Country:US
Mailing Address - Phone:702-366-1655
Mailing Address - Fax:702-942-4388
Practice Address - Street 1:3012 S. DURANGO DR.
Practice Address - Street 2:SUITE 1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-366-0640
Practice Address - Fax:702-366-9075
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV5557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002099Medicaid
C96331Medicare UPIN
NV002002099Medicaid