Provider Demographics
NPI:1154319218
Name:MCKELVEY, KEVIN P (CRNA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:P
Last Name:MCKELVEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 ESSEX WAY
Mailing Address - Street 2:
Mailing Address - City:GARNET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19061-2260
Mailing Address - Country:US
Mailing Address - Phone:215-485-2427
Mailing Address - Fax:
Practice Address - Street 1:3429 ESSEX WAY
Practice Address - Street 2:
Practice Address - City:GARNET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19061-2260
Practice Address - Country:US
Practice Address - Phone:215-485-2427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN282868L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA684367Medicare ID - Type Unspecified