Provider Demographics
NPI:1881971224
Name:KIELY, MARYELLE HERNDON (CRNA)
Entity type:Individual
Prefix:
First Name:MARYELLE
Middle Name:HERNDON
Last Name:KIELY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-620-4855
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:2100 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3941
Practice Address - Country:US
Practice Address - Phone:919-620-4917
Practice Address - Fax:919-620-4921
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2021-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC233422367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered