Healthcare Provider Details

I. General information

NPI: 1184619306
Provider Name (Legal Business Name): VIRGINIA LANE KELLY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIRGINIA LANE EVANS CRNA

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 MEDICAL CENTRE WAY SUITE 100
KNOXVILLE TN
37920
US

IV. Provider business mailing address

9000 EXECUTIVE PARK DRIVE - UPA PHYSICIANS C200
KNOXVILLE TN
37923
US

V. Phone/Fax

Practice location:
  • Phone: 606-337-3051
  • Fax: 606-337-2871
Mailing address:
  • Phone: 865-670-6700
  • Fax: 865-670-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1072826/4024A
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number14631
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: