Individual
BETHANY A KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4401 WORNALL RD, KANSAS CITY, MO 64111
(816) 932-3679
(816) 932-9089
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2010026479
MO
367500000X
Certified Registered Nurse Anesthetist
209021707
IL
367500000X
Certified Registered Nurse Anesthetist
7009-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MULTISPECIALTY GROUP PTAN
IL
Enumeration date
06/07/2016
Last updated
11/25/2020
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