Healthcare Provider Details

I. General information

NPI: 1962077768
Provider Name (Legal Business Name): NICOLE L ROBINSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 BALLENTINE ST
OVERLAND PARK KS
66214-1900
US

IV. Provider business mailing address

PO BOX 410273
KANSAS CITY MO
64141-0273
US

V. Phone/Fax

Practice location:
  • Phone: 913-636-2663
  • Fax:
Mailing address:
  • Phone: 913-680-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2023002813
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number43-558143-072
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: