Healthcare Provider Details

I. General information

NPI: 1265413272
Provider Name (Legal Business Name): KIMBERLY RENEE KELLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD TRIPLER ARMY MEDICAL CENTER
TRIPLER AMC HI
96859-5001
US

IV. Provider business mailing address

92-1001 ALIINUI DR APT 17B
KAPOLEI HI
96707-2255
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-2460
  • Fax: 808-433-1558
Mailing address:
  • Phone: 808-292-3192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35055699
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01095424A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: