NPI 1386747863 · live from the CMS NPI Registry
Anesthesia & Pain Management
Nurse Anesthetist, Certified Registered in Overland Park, KS. National Provider Identifier 1386747863, active.
NPI record
| NPI | 1386747863 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Nurse Anesthetist, Certified Registered 367500000X |
| Practice location | 8800 Ballentine, Overland Park, KS 66214 |
| Practice phone | 913-894-0384 |
| Mailing address | 940 West Port Plaza, Ste 270, St Louis, MO 63146 |
| Enumerated | September 7, 2006 |
| Last updated | September 11, 2025 |
| Authorized official | Robert Gibbons, President |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Anesthesiology, Pain Medicine | 207LP2900X | — |
| Nurse Anesthetist, Certified Registered primary | 367500000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.