Provider Demographics
NPI:1033126172
Name:CONDE, KENNETH JUDE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JUDE
Last Name:CONDE
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:1701 S 45TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106-2527
Mailing Address - Country:US
Mailing Address - Phone:913-721-3641
Mailing Address - Fax:913-721-3649
Practice Address - Street 1:4510 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3238
Practice Address - Country:US
Practice Address - Phone:816-364-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2015-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO154996367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10001878100OtherCOMMUNITY HEALTH PLAN
MO26162079OtherBLUE CROSS BLUE SHIELD KANSAS CITY
MO914815543Medicaid
KS100352140FMedicaid
KS145374OtherBLUE CROSS BLUE SHIELD KANSAS
KS16274OtherPREFERRED HEALTH SYSTEMS
KSP00402322OtherRAILROAD MEDICARE
MOP00365479OtherRAILROAD MEDICARE
MO10001878100OtherCOMMUNITY HEALTH PLAN
KS16274OtherPREFERRED HEALTH SYSTEMS
KSW49A155BMedicare PIN
KS145374OtherBLUE CROSS BLUE SHIELD KANSAS