Provider Demographics
NPI:1497241947
Name:CHANCE, KELSEY LAVELLE (CRNA)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:LAVELLE
Last Name:CHANCE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:BROOKE
Other - Last Name:LAVELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4147 PHILWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-3914
Mailing Address - Country:US
Mailing Address - Phone:901-833-1212
Mailing Address - Fax:
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:888-226-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN188717163W00000X
TN24764367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse