Healthcare Provider Details

I. General information

NPI: 1962518373
Provider Name (Legal Business Name): DEBBIE E KELLEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 GARFIELD STREET
TUPELO MS
38801
US

IV. Provider business mailing address

PO BOX 3294
TUPELO MS
38803-3294
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-4394
  • Fax: 662-377-7045
Mailing address:
  • Phone: 662-377-4394
  • Fax: 662-377-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR700754
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: