Healthcare Provider Details

I. General information

NPI: 1821214438
Provider Name (Legal Business Name): LORICIA LEA JENKINS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 NW NORTH RIDGE DRIVE, SUITE B ANESTHESIA SERVICES OF BLUE SPRINGS
BLUE SPRINGS MO
64014-6320
US

IV. Provider business mailing address

25012 W. 86TH TERRACE
LENEXA KS
66227-3522
US

V. Phone/Fax

Practice location:
  • Phone: 816-988-8415
  • Fax: 816-988-8395
Mailing address:
  • Phone: 316-304-3144
  • Fax: 913-745-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55593
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2007012542
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: