Healthcare Provider Details

I. General information

NPI: 1831175470
Provider Name (Legal Business Name): KENNETH J. REMINGTON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 W 119TH ST
OVERLAND PARK KS
66209-3722
US

IV. Provider business mailing address

10301 HICKMAN MILLS DR 100
KANSAS CITY MO
64137-1674
US

V. Phone/Fax

Practice location:
  • Phone: 816-763-5446
  • Fax:
Mailing address:
  • Phone: 816-763-5446
  • Fax: 816-763-8426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55351
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: