Provider Demographics
NPI:1023263225
Name:BUCCI, KELLY A (CRNA)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:BUCCI
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:610 W. GERMANTOWN PIKE, SUITE 150
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462
Mailing Address - Country:US
Mailing Address - Phone:610-525-4966
Mailing Address - Fax:706-650-1034
Practice Address - Street 1:595 W STATE STREET
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901
Practice Address - Country:US
Practice Address - Phone:215-345-2207
Practice Address - Fax:215-829-5567
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2023-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PARN525192L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA139835N7NMedicare PIN