Kelly Ann Waddilove

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

5412 Boulder Hwy
Las Vegas, NV 89122-6039

Phone

(702) 291-7121

Fax

(702) 507-2534

NPI assigned

Oct 23, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kelly Ann Bullock Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603411200000",
    "number": "1780283374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5340 DURALITE ST UNIT 203",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891227300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5412 BOULDER HWY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891226039",
            "telephone_number": "702-291-7121",
            "fax_number": "702-507-2534"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "850 Mill St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895021463",
            "country_code": "US",
            "telephone_number": "775-538-6700",
            "fax_number": "775-688-5878",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3312 W Charleston Blvd",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891021829",
            "country_code": "US",
            "telephone_number": "702-971-2300",
            "fax_number": "702-903-4447",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "315 Record St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895123327",
            "country_code": "US",
            "telephone_number": "775-405-4111",
            "fax_number": "775-688-5878",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WADDILOVE",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-23",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "k.waddilove@thwellcaregroup.com",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5412 Boulder Hwy",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891226039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "BULLOCK",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• W.B. Wellness L.L.C.
• W3Barc LLC
• Alexandrea Wabara, D.M.D.
• David Wach, D.C.
• Corey Adam Wachs, DC,CICE
• Kevin L Wadding, RN
• D'Artagnan Wade El
• Wade W. Wagner, D.D.S., CHTD
• Isis Wade-El
• Britney Wade

• Case Manager/Care Coordinator in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Case Manager/Care Coordinator in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.