Basic Information
Provider Information | |||||||||
NPI: | 1205871894 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHERBENSKE | ||||||||
FirstName: | KELLY | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 790058 | ||||||||
Address2: |   | ||||||||
City: | SAINT LOUIS | ||||||||
State: | MO | ||||||||
PostalCode: | 631790058 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6365492380 | ||||||||
FaxNumber: | 3145695974 | ||||||||
Practice Location | |||||||||
Address1: | 5530 WISCONSIN AVE | ||||||||
Address2: | SUITE 1620 | ||||||||
City: | CHEVY CHASE | ||||||||
State: | MD | ||||||||
PostalCode: | 208154404 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3017189800 | ||||||||
FaxNumber: | 3019861672 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/18/2006 | ||||||||
LastUpdateDate: | 10/21/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | AC000288 | MD | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   | 367500000X | 0024098517 | VA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   | 367500000X | ARNP9195291 | FL | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   | 367500000X | AP04119 | LA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   | 367500000X | 100796 | NE | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   | 367500000X | RN541659 | PA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
ID Information
ID | Type | State | Issuer | Description | 4191072 00 | 05 | MD |   | MEDICAID | 048497 | 01 |   | RECERT NURSE ANESTHETISTS | OTHER | KBC1CH | 01 | MD | CAREFIRST BCBS | OTHER | S417 0036 | 01 | DC | CAREFIRST BCBS | OTHER | G853-0002 | 01 | DC | NCA CAREFIRST PROVIDER # | OTHER | P00697535 | 01 | MD | MEDICARE RAILROAD (GRP PTAN DD6120) | OTHER |