KELLY BUCALO (NPI# 1992367080) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992367080 |
| Entity Type | Individual |
| Full Name | KELLY BUCALO |
| Credential | APRN |
| Practice Address |
911 N Buffalo Dr Unit 213 Las Vegas NV 89128-0381 |
| Practice Telephone | 7024058088 |
| Mailing Telephone | 7024058088 |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2020-02-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
820127 | NV | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
820127 | NV | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1180 N Town Center Dr Ste 100, Las Vegas, NV 891446308 | 7024752277 |
| Street Address |
911 N BUFFALO DR UNIT 213 |
| City | LAS VEGAS |
| State | NV |
| Zip Code | 89128-0381 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760411318 | Angela Alesi | Nurse Practitioner | 911 N Buffalo Dr Unit 213, Las Vegas, NV 89128-0381 | 2006-07-03 |
| 1205455961 | Changing Minds Medicine | Nurse Practitioner | 911 N Buffalo Dr Unit 213, Las Vegas, NV 89128-0381 | 2020-04-13 |
| 1730728585 | Valan Kam | Nurse Practitioner | 911 N Buffalo Dr Unit 213, Las Vegas, NV 89128-0381 | 2019-12-26 |
| 1760993117 | Nicole R Vaughn Changing Minds | Counselor | 911 N Buffalo Dr Unit 213, Las Vegas, NV 89128-0381 | 2017-10-12 |
| 1033628532 | Morgan Futch Moumouris | Counselor | 911 N Buffalo Dr Unit 213, Las Vegas, NV 89128-0381 | 2017-09-27 |
| 1558884031 | Erica R Arnold | Community/Behavioral Health | 911 N Buffalo Dr Unit 213, Las Vegas, NV 89128-0381 | 2017-07-17 |
| 1871015446 | Mary Louise Albert | Community/Behavioral Health | 911 N Buffalo Dr Unit 213, Las Vegas, NV 89128-0381 | 2017-07-14 |
| 1053852640 | Schuyler Ritchie | Behavioral Analyst | 911 N Buffalo Dr Unit 213, Las Vegas, NV 89128-0381 | 2017-03-15 |
| 1023469202 | Nicole Renee Vaughn | Nurse Practitioner | 911 N Buffalo Dr Unit 213, Las Vegas, NV 89128-0381 | 2016-06-28 |
| 1740642800 | Samantha Hiltz | Behavioral Analyst | 911 N Buffalo Dr Unit 213, Las Vegas, NV 89128-0381 | 2016-03-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699374256 | Dmc Medical Clinic Ltd | Family Medicine | 7140 Smoke Ranch Road, 150, Las Vegas, NV 89128 | 2020-10-23 |
| 1619589462 | Eldercare Services Lv, LLC | Technician | 8430 W. Lake Mead Blvd Suite 100, Las Vegas, NV 89128 | 2020-08-21 |
| 1508477308 | Amneris Lizet Duran-brocato | Technician | 1150 North Buffalo Dr. Apt 2120, Las Vegas, NV 89128 | 2020-08-14 |
| 1366082612 | Ar Home Health Management LLC | Home Health | 7465 W Lake Mead Blvd Suite 100, Las Vegas, NV 89128 | 2020-01-14 |
| 1114563731 | Leslie A Pasternack | Acupuncturist | Integrated Acupuncture of Southern Nevada, 7250 Peak Dr #106, Las Vegas, NV 89128 | 2019-11-19 |
| 1154977940 | Devora Susana Leon-lopez | Chore Provider | 7320 Smoke Ranch Rd. Ste. H, Las Vegas, NV 89128 | 2019-08-16 |
| 1659924884 | Blanca Estela Garnica-mendez | Chore Provider | 7320 Smoke Ranch Rd. Suite H, Suite H, Las Vegas, NV 89128 | 2019-07-17 |
| 1467913160 | Sherwin Necunazar Azad | Student in an Organized Health Care Education/Training Program | Mountainview Hospital Gme, 3100 N. Tenaya Way, Las Vegas, NV 89128 | 2019-03-26 |
| 1962963801 | Michael Richard Korczynski | Student in an Organized Health Care Education/Training Program | 3100 North Tenaya Way, Las Vegas, NV 89128 | 2019-03-25 |
| 1013477041 | Yuanlong Zhao | Student in an Organized Health Care Education/Training Program | 3100 N Tenaya Way Graduate Medical Education, Las Vegas, NV 89128 | 2019-03-25 |
| Find all providers in zip 89128 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801404074 | Ibukun Odutola | Nurse Practitioner | 2605 E Flamingo Rd, Las Vegas, NV 89121-5241 | 2020-07-14 |
| 1225652191 | Angela Beth Wilson | Nurse Practitioner | 5440 W Sahara Ave Ste 220, Las Vegas, NV 89146-0355 | 2020-06-05 |
| 1104445394 | Universal Psychiatry LLC | Nurse Practitioner | 270 E Flamingo Rd Unit 122, Las Vegas, NV 89169-0325 | 2020-04-09 |
| 1952931271 | Paramount Healthcare Services Corp | Nurse Practitioner | 10141 Rockridge Peak Ave, Las Vegas, NV 89166-5200 | 2020-01-26 |
| 1730642182 | Aban Medical Services | Nurse Practitioner | 10145 Eagle Haven St, Las Vegas, NV 89141-8781 | 2019-04-11 |
| 1750857728 | Jan Michael Arceo | Nurse Practitioner | 3140 S Rainbow Blvd Ste 401, Las Vegas, NV 89146-6234 | 2018-10-17 |
| 1780110247 | Jon A Failla Aprn Pllc | Nurse Practitioner | 182 Apache Tear Ct, Las Vegas, NV 89123-2996 | 2017-05-03 |
| 1023565074 | Bright Star Nurse Care LLC | Nurse Practitioner | 8337 Fox Brook St, Las Vegas, NV 89139-6755 | 2016-09-07 |
| 1467805119 | Kasey James Dean | Nurse Practitioner | 3321 N Buffalo Dr, Suite 200, Las Vegas, NV 89129-6678 | 2016-07-18 |
| 1558757021 | Martin Binyange | Nurse Practitioner | 320 E Warm Springs Rd Unit 1, Las Vegas, NV 89119-4243 | 2015-04-12 |
| Find all providers in LAS VEGAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.