Individual
KELLY J ESTES-BACCHUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
20201 CRAWFORD AVE, SOUTHWEST ANESTHESIA CONSULTANTS, OLYMPIA FIELDS, IL 60461-1010
(708) 503-3857
(708) 503-3806
Mailing address
6225 N STATE HIGHWAY 161 STE 200, IRVING, TX 75038-2241
(214) 687-0898
(214) 687-0991
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041-311249
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209006926
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041311249
—
IL
Enumeration date
08/31/2007
Last updated
09/22/2021
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