Individual
KENT M FELLERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
14000 FIVAY RD, HUDSON, FL 34667-7103
(260) 484-8551
(260) 482-5060
Mailing address
5052 N CLINTON ST, FORT WAYNE, IN 46825-5822
(260) 484-8551
(260) 482-5060
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
051088
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
28108380A
IN
367500000X
Certified Registered Nurse Anesthetist
RN229962
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000675839
ANTHEM
IN
05
—
200998230
—
IN
Enumeration date
07/30/2006
Last updated
04/06/2020
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