Healthcare Provider Details

I. General information

NPI: 1154098671
Provider Name (Legal Business Name): KELLER PHALEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HOSPITAL DR
MADISON TN
37115-5030
US

IV. Provider business mailing address

1201 CHURCH ST APT 570
NASHVILLE TN
37203-3687
US

V. Phone/Fax

Practice location:
  • Phone: 615-732-7671
  • Fax:
Mailing address:
  • Phone: 219-776-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0000242014
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number33193
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: