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General NPI Number Information
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NPI Number | 1508822032
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Entity Type | Individual
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Provider Name | BRADLEY S. KELLER CRNA
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Gender | Male
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1801 GUNBARREL RD
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City | CHATTANOOGA
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State | TN
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Zip | 37421-3130
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Country | US
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Telephone | 423-855-6861
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Fax |
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Provider Business Mailing Address
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Address Line | 7446 BRITISH RD
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City | OOLTEWAH
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State | TN
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Zip | 37363-5511
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Country | US
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Telephone | 423-344-9826
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APN0000010562
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License Number State | TN
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