MEDICARE: VIRGINIA LANE KELLY CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	1072826/4024A	KY
2	367500000X	Certified Registered Nurse Anesthetist	14631	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00078424	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000276584	OTHER		ANTHEM BC&BS

General Provider Information

NPI Number	:	1184619306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA LANE KELLY CRNA

Provider Business Mailing Address
First Line	:	9000 EXECUTIVE PARK DRIVE - UPA PHYSICIANS
Second Line	:	C200
City	:	KNOXVILLE
State	:	TN
Zip	:	37923
Country	:	US
Telephone Number	:	865-670-6700
Fax Number	:	865-670-6142

Provider Business Practice Location Address
First Line	:	2121 MEDICAL CENTRE WAY
Second Line	:	SUITE 100
City	:	KNOXVILLE
State	:	TN
Zip	:	37920
Country	:	US
Telephone Number	:	606-337-3051
Fax Number	:	606-337-2871

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	12/26/2024

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Directions to “ VIRGINIA LANE KELLY CRNA” Practice Location

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