Healthcare Provider Details

I. General information

NPI: 1760709836
Provider Name (Legal Business Name): THERESA L SIMPELO CAIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA L SIMPELO

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CLAY EDWARDS DR
NORTH KANSAS CITY MO
64116-3220
US

IV. Provider business mailing address

1900 SWIFT AVE STE 203 P O BOX 7391
NORTH KANSAS CITY MO
64116-3400
US

V. Phone/Fax

Practice location:
  • Phone: 816-221-5050
  • Fax: 816-471-1247
Mailing address:
  • Phone: 816-221-5050
  • Fax: 816-471-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number132225
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number132225
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: