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General NPI Number Information
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NPI Number | 1073390431
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Entity Type | Individual
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Provider Name | SCOTT FANKHAUSER CRNA
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Gender | Male
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 9100 W 74TH ST
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City | SHAWNEE MISSION
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State | KS
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Zip | 66204-4004
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Country | US
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Telephone | 913-632-2230
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Fax | 913-632-2297
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Provider Business Mailing Address
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Address Line | PO BOX 411895
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City | KANSAS CITY
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State | MO
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Zip | 64141-1895
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Country | US
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Telephone | 913-647-4100
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Fax | 913-647-4120
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 111002
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 558242
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License Number State | KS
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