Basic Information
| Provider Information | |||||||||
| NPI: | 1366493140 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARDNER | ||||||||
| FirstName: | KELLEY | ||||||||
| MiddleName: | RHENE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 966 | ||||||||
| Address2: | SUTTER CREEK OB ANESTHESIA | ||||||||
| City: | SUTTER CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882700340 | ||||||||
| FaxNumber: | 8882700340 | ||||||||
| Practice Location | |||||||||
| Address1: | 7500 TIMBERLAKE | ||||||||
| Address2: | METHODIST HOSPITAL | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164233000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN244086 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | NA242 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | RN244086 | 05 | CA | MEDICAID | NA242 | 05 | CA | MEDICAID |