Individual provider Active NPI

John R Kelley, CRNA

  • Certified Registered Nurse Anesthetist
  • Florence, AL
National Provider Identifier
1669610648
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1-096865 Issued in AL
Practice address
103 Helton CT
Florence, AL 35630-1464
Phone
(256) 760-0672
NPI assigned
Jan 28, 2009
Last updated
Jun 6, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 2025018932 MO
Certified Registered Nurse Anesthetist 367500000X 1-096865 AL Primary

Addresses

Primary practice location

103 Helton CT
Florence, AL 35630-1464

Mailing address

PO Box 235022
Montgomery, AL 36123-5022
Phone (334) 396-6930

Other practice location 1

100 Hospital Dr
Lebanon, MO 65536-9210
Phone (417) 533-6026

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, MO, MS3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20090406000245 AL Practitioner - Certified Registered Nurse Anesthetist (Crna) 1052468204 Reassigns benefits to 2 organizations
I20250616001035 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 1052468204 Reassigns benefits to 2 organizations
I20250825004294 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 1052468204 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2008
Medicare assignment
May accept Medicare assignment
Group practices
Namc Anesthesia Services LLCGroup PAC ID 3476959966, 28 clinicians

Practice addresses (Care Compare)

1701 Veterans Dr
Florence, AL 35630-4928
Phone (256) 629-1900

830 S Gloster
North Ms Med Ctr Sleep Lab
Tupelo, MS 38801-4934
Phone (662) 377-3258

830 S Gloster St
Tupelo, MS 38801-4934

830 S Gloster St 3Rd FL E Tower
Tupelo, MS 38801-4934

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
901995MSMDFamily Nurse Practitioner
1-096865ALMDCertified Registered Nurse Anesthetist
2025018932MOMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
RCHP - Florence LLC Nurse Anesthetist, Certified Registered CurrentSince Sep 4, 2019 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jun 2, 2025 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jun 2, 2025 Accepting new patients
Namc Anesthesia Services LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2021 Accepting new patients
North Mississippi Medical Center CurrentSince Jul 21, 2025 Accepting new patients
North Mississippi Medcial Center, Inc. CurrentSince Jul 21, 2025 Accepting new patients
North Mississippi Medical Center Inc Current Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jun 2, 2025 Accepting new patients
Tupelo Anesthesia Group PA Past Accepting new patients

Locations

1701 Veterans Dr
Florence, AL 35630
Phone (256) 629-1900

201 Avalon Ave
Muscle Shoals, AL 35661
Phone (256) 386-1600

100 Hospital Dr
Lebanon, MO 65536
Phone (417) 533-6010

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136

Organizations & group practices 9

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

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1233100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1669610648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 235022",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361235022",
            "telephone_number": "334-396-6930",
            "fax_number": "334-396-6929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 HELTON CT",
            "city": "FLORENCE",
            "state": "AL",
            "postal_code": "356301464",
            "telephone_number": "256-760-0672"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "MO",
            "postal_code": "655369210",
            "country_code": "US",
            "telephone_number": "417-533-6026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "JOHN",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-28",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2025018932",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AL",
            "license": "1-096865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.