Individual
MICHAEL D KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
250 S 21ST ST, EASTON, PA 18042-3851
(610) 250-4303
(610) 250-4846
Mailing address
PO BOX 650782, DALLAS, TX 75265-0782
(215) 442-5085
(877) 329-2370
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
26NJ00335100
NJ
367500000X
Certified Registered Nurse Anesthetist
Primary
RN316546L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
075242
AANA ID
PA
05
—
101495676
—
PA
01
—
26NR08257400
REGISTERED PROF NURSE
NJ
01
—
P00678819
RAILROAD MEDICARE
PA
Enumeration date
10/17/2005
Last updated
02/29/2012
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