Provider Demographics
NPI:1063717460
Name:FRANKOWICZ, KELLEY GOODMAN (CRNA)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:GOODMAN
Last Name:FRANKOWICZ
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 3185
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-3185
Mailing Address - Country:US
Mailing Address - Phone:318-998-6129
Mailing Address - Fax:
Practice Address - Street 1:312 GRAMMONT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7457
Practice Address - Country:US
Practice Address - Phone:318-998-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS883932367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered