Kelly Bacon
Kelly Bacon is a Certified Registered Nurse Anesthetist (CRNA) in Idabel, Oklahoma. Qualified in 2003, 23 years ago. Practices with Western Oklahoma Anesthesia Consultants PLLC, a 15-clinician group and accepts Medicare assignment. Licensed in Oklahoma.
- Years since qualifying
- 23
- Licensed in
- OK
- In the registry since
- 2006
- Specialties on file
- 2
Practice location Address checks out
1301 E Lincoln RdIdabel, OK 74745-7300
Phone: (580) 286-7623
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Certified Registered Nurse Anesthetist (primary) | Taxonomy 367500000X · Licence R0071221 (OK) |
|---|---|
| Anesthesiologist Assistant | Taxonomy 367H00000X · Licence R0071221 (OK) |
Record details
| NPI number | 1700844313 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | May 3, 2006 |
| Last updated in NPPES | October 26, 2021 |
| Certification date | October 26, 2021 |
| Mailing address | Po Box 1547, Sedalia, MO 65302-1547 |
Medicare enrollment
| Medicare specialty | CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
|---|---|
| Medical school | OTHER |
| Graduated | 2003 (23 years in practice) |
| Group practice | Western Oklahoma Anesthesia Consultants Pllc — 15 clinicians |
| Accepts Medicare assignment | Yes — accepts the Medicare-approved amount |
| Practice locations | 2 on file with Medicare |