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NPI Code Detail

MEDICARE: KELLY JEAN MARTIN CRNA

MEDICARE: KELLY JEAN MARTIN 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
1367500000XCertified Registered Nurse Anesthetist133715TX
2367500000XCertified Registered Nurse Anesthetist0024188172VA
3367500000XCertified Registered Nurse Anesthetist1046794TX

General Provider Information

NPI Number : 1235706953
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY JEAN MARTIN CRNA
Provider Business Mailing Address
First Line : PO BOX 840853
Second Line :
City : DALLAS
State : TX
Zip : 75284-0853
Country : US
Telephone Number : 972-233-1999
Fax Number : 972-233-3666
Provider Business Practice Location Address
First Line : 7101 JAHNKE RD
Second Line :
City : RICHMOND
State : VA
Zip : 23225-4017
Country : US
Telephone Number : 804-483-0745
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2021
Last Update Date : 12/10/2025

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