Healthcare Provider Details

I. General information

NPI: 1255376760
Provider Name (Legal Business Name): KIMBERLY A MOEHLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11413 ASH ST STE 100
LEAWOOD KS
66211-1692
US

IV. Provider business mailing address

14219 KENNEDY RD
GREENWOOD MO
64034-8234
US

V. Phone/Fax

Practice location:
  • Phone: 913-661-9977
  • Fax: 913-661-9577
Mailing address:
  • Phone: 816-529-6463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number124621
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54669
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: