Individual
MRS. JENNIFER E DICKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
9100 W 74TH ST, SHAWNEE MISSION, KS 66204-4004
(913) 632-2230
(913) 632-2297
Mailing address
PO BOX 411895, KANSAS CITY, MO 64141-1895
(913) 632-2230
(913) 632-2297
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1387364012
KS
163W00000X
Registered Nurse
2003009967
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
55555
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200420350A
—
KS
01
—
37862013
BCBS KC
KS
05
—
917432205
—
MO
01
—
P00379659
RR MEDICARE
KS
Enumeration date
12/18/2006
Last updated
11/24/2020
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