John L Kelly IV, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

173219 Issued in TX

Practice address

2411 Fountain View Dr
Suite 200
Houston, TX 77057-4817

Phone

(713) 620-4000

NPI assigned

Jul 26, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Anesthesia Associates PA

  • Anesthesiology Physician
  • Statesville, NC
  • NPI 1699723791
  NPD
• Carolina Regional Anesthesia PLLC

  • Certified Registered Nurse Anesthetist
  • Pinehurst, NC
  • NPI 1891072609

  Anesthesiology

  NPD
• Coastal Carolina Sedation Associates, LLC

  • Certified Registered Nurse Anesthetist
  • Wilmington, NC
  • NPI 1114544996

  Anesthesiology

  NPD
• Amsol Anesthetists of Murrells Inlet, SC

  • Anesthesiology Physician
  • Murrells Inlet, SC
  • NPI 1376588384
  NPD (past)
• Lexington Medical Center

  • General Acute Care Hospital
  • Lexington, NC
  • NPI 1417958331
  NPD (past)
• Martinsville Anesthesia, PC

  • Anesthesiology Physician
  • Martinsville, VA
  • NPI 1760437115
  NPD (past)
• Nurse Anesthesia of North Carolina, PLLC

  • Certified Registered Nurse Anesthetist
  • Elizabeth City, NC
  • NPI 1689628729

  Nurse Anesthetist, Certified Registered

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395878400000",
    "number": "1467476259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2411 FOUNTAIN VIEW DR",
            "address_2": "SUITE 200",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770574817",
            "telephone_number": "713-620-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2411 FOUNTAIN VIEW DR",
            "address_2": "SUITE 200",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770574817",
            "telephone_number": "713-620-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JOHN",
        "middle_name": "L",
        "name_suffix": "IV",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2014-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "173219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8104UU",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202817701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gloria Kelly, MA
• Gracen Kelly, MS
• Jeana Kelly, PA-C
• Joe Kelly, O.P.A.C.,CST/FA
• John Daniel Kelly, M.D.
• John M Kelly, MD
• Joyacelyn Ryan Kelly
• Katherine Casey Kelly, N.N.P.
• Kathryn Marie Kelly, CRNA
• Kristen Elizabeth Kelly, MS, CGC

• Certified Registered Nurse Anesthetist in Houston, TX
• Providers in Houston, TX by specialty
• Certified Registered Nurse Anesthetist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.