Healthcare Provider Details

I. General information

NPI: 1639934821
Provider Name (Legal Business Name): KATIE JUSTINE KORNEMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 W 74TH ST
MERRIAM KS
66204-4004
US

IV. Provider business mailing address

117 W 20TH ST APT 707
KANSAS CITY MO
64108-2087
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2026000994
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number43-558377-021
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95002657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: