Healthcare Provider Details

I. General information

NPI: 1699221663
Provider Name (Legal Business Name): KELLY ANN WARTERS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY EVANS

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LIBBY CT
TELFORD PA
18969-1366
US

IV. Provider business mailing address

51 N 39TH ST
PHILADELPHIA PA
19104-2640
US

V. Phone/Fax

Practice location:
  • Phone: 570-592-8820
  • Fax: 215-274-3560
Mailing address:
  • Phone: 215-662-8244
  • Fax: 215-274-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN638939
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: