Healthcare Provider Details

I. General information

NPI: 1760807499
Provider Name (Legal Business Name): KERI KEMP CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19609 NEWTON AVE
STILWELL KS
66085-9338
US

IV. Provider business mailing address

19609 NEWTON AVE
STILWELL KS
66085-9338
US

V. Phone/Fax

Practice location:
  • Phone: 913-634-5669
  • Fax:
Mailing address:
  • Phone: 913-634-5669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4023737
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number43-557241-091
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: