Provider Demographics
NPI:1083920714
Name:HERMS, KELLY COLLEEN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:COLLEEN
Last Name:HERMS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:KNUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4932 SW BIMINI CIR N
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-1232
Mailing Address - Country:US
Mailing Address - Phone:810-434-2909
Mailing Address - Fax:
Practice Address - Street 1:4932 SW BIMINI CIR N
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-1232
Practice Address - Country:US
Practice Address - Phone:810-434-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704265066163W00000X, 367500000X
FL11015969367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse