Provider Demographics
NPI:1669426938
Name:LEONARD, KELLY K (CRNA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:K
Last Name:LEONARD
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 1252
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37133-1252
Mailing Address - Country:US
Mailing Address - Phone:615-396-4464
Mailing Address - Fax:615-396-6748
Practice Address - Street 1:1800 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2567
Practice Address - Country:US
Practice Address - Phone:615-396-4464
Practice Address - Fax:615-396-6748
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000074360367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3122911OtherBCBS
TN4182584OtherBCBS EFFECTIVE 5/1/08
TN3626966Medicaid
TN430044913OtherRR MEDICARE
TN3122911OtherBCBS