Provider Demographics
NPI:1033476874
Name:KELLEY, VICTORIA MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:MARIE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:MARIE
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:8213 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-1060
Mailing Address - Country:US
Mailing Address - Phone:330-569-4963
Mailing Address - Fax:
Practice Address - Street 1:6847 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3929
Practice Address - Country:US
Practice Address - Phone:330-569-4963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.0020904367500000X
OHPN.139832-M-IV164W00000X
OH421097163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine