Provider Demographics
NPI:1386677854
Name:RECHTIN, KELLY M (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:M
Last Name:RECHTIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:PIERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 64382
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4382
Mailing Address - Country:US
Mailing Address - Phone:410-550-8432
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:JOHNS HOPKINS HOSPITAL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-502-2762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166871367500000X
IN28151920A367500000X
MDR187508367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA139180OtherANTHEM
MD023630600Medicaid
VA1386677854Medicaid
VA484645OtherNCPPO
DCK142-0002OtherCAREFIRST
VAP00376344Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MD023630600Medicaid
DCK142-0002OtherCAREFIRST
VA011039F81Medicare PIN