Healthcare Provider Details

I. General information

NPI: 1568960979
Provider Name (Legal Business Name): KELLY KATHARINE BAUMES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 NORTH ST
PITTSFIELD MA
01201-4109
US

IV. Provider business mailing address

PO BOX 797
LENOX MA
01240-0797
US

V. Phone/Fax

Practice location:
  • Phone: 413-447-2000
  • Fax:
Mailing address:
  • Phone: 616-566-0347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2320236
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: