Provider Demographics
NPI:1861448524
Name:PETERSON, PAUL (CRNA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9233 WARD PKWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3366
Mailing Address - Country:US
Mailing Address - Phone:816-389-6030
Mailing Address - Fax:816-389-6034
Practice Address - Street 1:12300 METCALF AVE
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:816-389-6030
Practice Address - Fax:816-389-6034
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2023-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS54581367500000X
MO093647367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS19059024OtherBCBS NUMBER
KSJ884034Medicare ID - Type UnspecifiedKS MEDICARE NUMBER