Provider Demographics
NPI:1184892499
Name:MARCHMAN, KELLI (CRNA)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:
Last Name:MARCHMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:AUSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1118 ROSS CLARK CIR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3001
Mailing Address - Country:US
Mailing Address - Phone:334-793-5105
Mailing Address - Fax:334-671-5073
Practice Address - Street 1:1118 ROSS CLARK CIR
Practice Address - Street 2:SUITE 700
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3001
Practice Address - Country:US
Practice Address - Phone:334-793-5105
Practice Address - Fax:334-671-5073
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLANT9229432367500000X
AL1-100416367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLANT9229432OtherLICENSE
AL1-10046OtherAL LICENSE
FLG4452OtherBCBS