Healthcare Provider Details

I. General information

NPI: 1215490974
Provider Name (Legal Business Name): MICHAEL D PARTRIDGE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 E MEYER BLVD
KANSAS CITY MO
64132-1136
US

IV. Provider business mailing address

8717 WEST 110TH ST. STE 600
OVERLAND PARK KS
66210
US

V. Phone/Fax

Practice location:
  • Phone: 913-428-2900
  • Fax: 913-428-2951
Mailing address:
  • Phone: 913-428-2900
  • Fax: 914-428-2951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2012017524
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2019017170
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: