Healthcare Provider Details

I. General information

NPI: 1528037074
Provider Name (Legal Business Name): KIMBERLY K VAN GUNDY C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 NE CARNEGIE DR
LEES SUMMIT MO
64064-3222
US

IV. Provider business mailing address

3911 W 74TH TER
PRAIRIE VILLAGE KS
66208-2952
US

V. Phone/Fax

Practice location:
  • Phone: 816-347-0026
  • Fax:
Mailing address:
  • Phone: 913-777-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number320756
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP13618
License Number StateVI
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number140860
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number43-557132-011
License Number StateKS
# 5
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD085712
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: