Provider Demographics
NPI:1962279968
Name:LIGGONS, KELLY VASHON (FNP-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:VASHON
Last Name:LIGGONS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 SAN MATEO ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89085-2304
Mailing Address - Country:US
Mailing Address - Phone:317-833-5620
Mailing Address - Fax:
Practice Address - Street 1:7210 W LAKE MEAD BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8353
Practice Address - Country:US
Practice Address - Phone:702-202-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV873589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily