Provider Demographics
NPI:1124041884
Name:REARDON, ECHO RENEE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ECHO
Middle Name:RENEE
Last Name:REARDON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ECHO
Other - Middle Name:R
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:ONE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-2568
Practice Address - Fax:855-903-0985
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001650367500000X
IL041285078163W00000X
IN28187929A163W00000X
MO2022006185367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
50148OtherAANA
IL214881OtherMULTI SPECIALTY GROUP PTAN
50148OtherAANA
ILK26121Medicare ID - Type Unspecified