Individual
TERRI ELLEN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1421 N 7TH ST, TERRE HAUTE, IN 47807-1005
(812) 234-8261
(812) 234-8262
Mailing address
PO BOX 3849, TERRE HAUTE, IN 47803-0849
(812) 234-8261
(812) 234-8262
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28170574A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000508494
BLUE CROSS/BLUE SHIELD
IN
05
—
200853750
—
IN
Enumeration date
03/06/2007
Last updated
03/12/2008
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