Provider Demographics
NPI:1548203391
Name:KATCHER, KELLY RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:RENEE
Last Name:KATCHER
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 1:2419 GRANADA BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1340
Mailing Address - Country:US
Mailing Address - Phone:773-936-6440
Mailing Address - Fax:
Practice Address - Street 1:7160 RAFAEL RIVERA WAY STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-5395
Practice Address - Country:US
Practice Address - Phone:888-339-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110671207L00000X
CT79605207L00000X
TXP5540207L00000X
NV18574207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01292155OtherRAILROAD MEDICARE
TX321781201Medicaid
TX8DT434OtherBLUE CROSS BLUE SHIELD
TX285153YK6UMedicare PIN