Healthcare Provider Details

I. General information

NPI: 1750367017
Provider Name (Legal Business Name): DAVID W. KELLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 E MARSHALL ST
WEST CHESTER PA
19380-4413
US

IV. Provider business mailing address

708 E MARSHALL ST
WEST CHESTER PA
19380-4413
US

V. Phone/Fax

Practice location:
  • Phone: 610-431-5472
  • Fax: 610-430-2914
Mailing address:
  • Phone: 610-431-5472
  • Fax: 610-430-2914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN255960L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: