Healthcare Provider Details

I. General information

NPI: 1962707547
Provider Name (Legal Business Name): KELLY H. METTS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 FOREST DR
COLUMBIA SC
29204-2026
US

IV. Provider business mailing address

PO BOX 1467
COLUMBIA SC
29202-1467
US

V. Phone/Fax

Practice location:
  • Phone: 803-765-1838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4433
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: