Individual
KELLEY COLLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
501 20TH ST, SUITE 606, KNOXVILLE, TN 37916-1809
(865) 546-8040
(865) 541-2787
Mailing address
501 20TH ST, SUITE 606, KNOXVILLE, TN 37916-1809
(865) 546-8040
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
11334
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100039898
PHP TENNCARE
TN
05
—
3868699
—
TN
01
—
4088332
BLUE CROSS
TN
01
—
P00178099
MEDICARE TRAVELERS
TN
Enumeration date
10/11/2006
Last updated
06/29/2010
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