Healthcare Provider Details

I. General information

NPI: 1497804116
Provider Name (Legal Business Name): KELLY S BATTS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 RIDGE RD SUITE 202
ROXBORO NC
27573-4629
US

IV. Provider business mailing address

150 KADER MERRITT RD
ROSE HILL NC
28458-8672
US

V. Phone/Fax

Practice location:
  • Phone: 336-503-5640
  • Fax:
Mailing address:
  • Phone: 910-532-6532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number141561
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: