Individual
MARTIN J KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2710 RIFE MEDICAL LN, ROGERS, AR 72758-1452
(913) 642-4900
(913) 381-0979
Mailing address
PO BOX 507, LOWELL, AR 72745-0507
(913) 642-4900
(913) 381-0979
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C002728
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176438001
—
AR
01
—
5V105
BCBS
AR
01
—
604337200
DOL
AR
01
—
P00849069
RR
AR
Enumeration date
12/18/2007
Last updated
11/07/2013
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