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Individual

KENNETH GERGELY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
Mailing address
65 QUEEN REGENT CT, BLUE RIDGE, VA 24064-1521

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001-190814
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024-166359
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010100160
VA
05
010100186
VA
05
010111331
VA
05
010111358
VA
05
010111391
VA
Enumeration date
04/21/2006
Last updated
05/06/2008
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