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NPI Code Detail

MEDICARE: CHRISTOPHER PAUL KELLY CRNA

MEDICARE: CHRISTOPHER PAUL 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
1367500000XCertified Registered Nurse AnesthetistRN 96601TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24047865OTHERTNBLUE CROSS/BLUE SHIELD TN

General Provider Information

NPI Number : 1942265244
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER PAUL KELLY CRNA
Provider Business Mailing Address
First Line : 204 POPLAR ST
Second Line :
City : MARTIN
State : TN
Zip : 38237-3121
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 161 MOUNT PELIA RD
Second Line :
City : MARTIN
State : TN
Zip : 38237-3811
Country : US
Telephone Number : 731-588-0001
Fax Number : 731-587-2775
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2006
Last Update Date : 10/13/2011

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Directions to “ CHRISTOPHER PAUL KELLY CRNA” Practice Location

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