Individual
MR. THOMAS PATRICK KELLY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2301 EASTERN AVE, RED OAK, IA 51566-0498
(712) 623-7000
(712) 623-7224
Mailing address
PO BOX 498, RED OAK, IA 51566-0498
(712) 623-7000
(712) 623-7224
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
D058063
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0455543
—
IA
Enumeration date
09/27/2005
Last updated
07/09/2007
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