Provider Demographics
NPI:1386986875
Name:NOALL, KELLY (CRNA)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:NOALL
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 1:15850 GREY FRIARS CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-3906
Mailing Address - Country:US
Mailing Address - Phone:239-851-3315
Mailing Address - Fax:
Practice Address - Street 1:1336 CREEKSIDE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1931
Practice Address - Country:US
Practice Address - Phone:239-261-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9282695367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered