Provider Demographics
NPI:1306809405
Name:WALKER BEIRNE, KELLY (CRNA)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:WALKER BEIRNE
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 1:2033 S PATRICK DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4418
Mailing Address - Country:US
Mailing Address - Phone:321-773-9898
Mailing Address - Fax:321-773-3354
Practice Address - Street 1:2033 S PATRICK DR
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4418
Practice Address - Country:US
Practice Address - Phone:321-773-9898
Practice Address - Fax:321-773-3354
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2358367500000X
FL2644822367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2323BMedicare UPIN