Individual
JOHN L KELLY IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2411 FOUNTAIN VIEW DR, SUITE 200, HOUSTON, TX 77057-4817
(713) 620-4000
Mailing address
2411 FOUNTAIN VIEW DR, SUITE 200, HOUSTON, TX 77057-4817
(713) 620-4000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
173219
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202817701
—
TX
01
—
8104UU
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/26/2006
Last updated
03/27/2014
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