Healthcare Provider Details

I. General information

NPI: 1508301805
Provider Name (Legal Business Name): KELSEY VERA MOSS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY VERA RUNNALLS

II. Dates (important events)

Enumeration Date: 12/23/2016
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARK ST
GLENS FALLS NY
12801-4413
US

IV. Provider business mailing address

100 PARK ST
GLENS FALLS NY
12801-4413
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number291293
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11036664
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number433483
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number631978
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number631978
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: