Healthcare Provider Details

I. General information

NPI: 1417387440
Provider Name (Legal Business Name): KELLI BAGATINI MARREE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MON HEALTH MEDICAL PARK DR STE 2001
MORGANTOWN WV
26505-1167
US

IV. Provider business mailing address

PO BOX 3466
CHARLESTON WV
25334-3466
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-8816
  • Fax: 904-494-6467
Mailing address:
  • Phone: 304-720-8816
  • Fax: 904-494-6467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN80644
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: