Provider Demographics
NPI:1861470882
Name:GUSS, KELLI (CRNA)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:GUSS
Suffix:
Gender:F
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:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:713-620-4000
Mailing Address - Fax:
Practice Address - Street 1:1500 CITYWEST BLVD STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042
Practice Address - Country:US
Practice Address - Phone:713-620-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629138367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8162UBOtherBLUE CROSS BLUE SHIELD
TX182642203Medicaid
TX182642204Medicaid
TX8F20740Medicare PIN
TX182642204Medicaid
TX8L16228Medicare PIN
TXTXB137977Medicare PIN
TX83183HMedicare PIN
TX8162UBOtherBLUE CROSS BLUE SHIELD
TX87535HMedicare ID - Type Unspecified
TX8B7226Medicare PIN
TX8D0900Medicare PIN
TX85076HMedicare PIN
TX83984HMedicare PIN