Provider Demographics
NPI:1205871894
Name:SCHERBENSKE, KELLY J (CRNA)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:J
Last Name:SCHERBENSKE
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 790058
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0058
Mailing Address - Country:US
Mailing Address - Phone:636-549-2380
Mailing Address - Fax:314-569-5974
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1620
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-718-9800
Practice Address - Fax:301-986-1672
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000288367500000X
VA0024098517367500000X
FLARNP9195291367500000X
LAAP04119367500000X
NE100796367500000X
PARN541659367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4191072 00Medicaid
048497OtherRECERT NURSE ANESTHETISTS
MDKBC1CHOtherCAREFIRST BCBS
DCS417 0036OtherCAREFIRST BCBS
DCG853-0002OtherNCA CAREFIRST PROVIDER #
MDP00697535OtherMEDICARE RAILROAD (GRP PTAN DD6120)
048497OtherRECERT NURSE ANESTHETISTS
VA011595A59Medicare ID - Type UnspecifiedPROVIDER NUMBER
MDKBC1CHOtherCAREFIRST BCBS
MD4191072 00Medicaid
DCG853-0002OtherNCA CAREFIRST PROVIDER #