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General NPI Number Information
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NPI Number | 1467133546
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Entity Type | Individual
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Provider Name | CARLY JO MCCLELAND CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 10500 QUIVIRA RD
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City | OVERLAND PARK
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State | KS
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Zip | 66215-2306
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Country | US
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Telephone | 913-541-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 8717 W 110TH ST STE 600
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City | OVERLAND PARK
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State | KS
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Zip | 66210-2126
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Country | US
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Telephone | 913-428-2900
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Fax | 913-428-2951
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 2016013693
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 041513364
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License Number State | IL
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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 | 43-558212
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License Number State | KS
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