Stephen Earl Kelley, CRNA
Nurse Anesthetist, Certified Registered in Memphis, TN. Individual provider (NPI-1).
NPI number1760831754
StatusActive
Last updated in NPPESJun 15, 2018
Details
- NPI
- 1760831754
- Entity type
- Individual (NPI-1)
- Name
- Stephen Earl Kelley
- Credential
- CRNA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 9, 2016
- Last updated
- Jun 15, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 28228678A | IN | Yes |
| 367500000X | Nurse Anesthetist, Certified Registered | 24275 | TN | |
| 163W00000X | Registered Nurse | 28228678A | IN |
Practice location
877 Jefferson AveMemphis, TN 38103
Phone 901-545-7100
Mailing address
12215 Lanai DrFort Wayne, IN 46818-8552
Phone 901-240-3671
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