Individual
JASON LEE RICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2817 SAINT JOHNS BLVD, ANESTHESIA DEPT, JOPLIN, MO 64804-1563
(417) 781-2727
Mailing address
2817 SAINT JOHNS BLVD, ANESTHESIA DEPT, JOPLIN, MO 64804-1563
(417) 781-2727
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2011020379
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104114073
—
MO
05
—
188858001
—
AR
05
—
200397640A
—
OK
05
—
200739210A
—
KS
Enumeration date
07/13/2011
Last updated
02/17/2012
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