Individual
SHIRLEY A KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
8001 YOUREE DR, SHREVEPORT, LA 71115-2302
(318) 212-3220
Mailing address
5721 LAKEFRONT DR, SHREVEPORT, LA 71119-3913
(318) 635-2617
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN036895
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN036895AP02547
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1901822
—
LA
Enumeration date
12/05/2005
Last updated
08/25/2008
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