Individual
VIRGINIA LANE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2121 MEDICAL CENTRE WAY, SUITE 100, KNOXVILLE, TN 37920
(606) 337-3051
(606) 337-2871
Mailing address
9000 EXECUTIVE PARK DRIVE - UPA PHYSICIANS, C200, KNOXVILLE, TN 37923
(865) 670-6700
(865) 670-6142
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1072826/4024A
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
14631
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000276584
ANTHEM BC&BS
—
05
—
74006362
—
KY
01
—
P00078424
RAILROAD MEDICARE
KY
Enumeration date
09/14/2005
Last updated
12/26/2024
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