Provider Demographics
NPI:1053361626
Name:WATKINS, KELLI L (CRNA)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:L
Last Name:WATKINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:L
Other - Last Name:SCHEIDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4045
Practice Address - Fax:682-885-7497
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX643025367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172143305Medicaid
TXTXB112724Medicare PIN