Individual
STEPHEN EARL KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
877 JEFFERSON AVE, MEMPHIS, TN 38103
(901) 545-7100
Mailing address
12215 LANAI DR, FORT WAYNE, IN 46818-8552
(901) 240-3671
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28228678A
IN
367500000X
Certified Registered Nurse Anesthetist
24275
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
28228678A
IN
Other
Enumeration date
06/09/2016
Last updated
06/15/2018
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