Provider Demographics
NPI:1144313834
Name:ABBOTT, RICK (CRNA)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 FARIWAY DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1576
Mailing Address - Country:US
Mailing Address - Phone:785-621-4793
Mailing Address - Fax:
Practice Address - Street 1:3701 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1576
Practice Address - Country:US
Practice Address - Phone:785-769-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54093367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS54093OtherLICENSE
KS144837OtherBLUE SHIELD
KS100244180FMedicaid