Provider Demographics
NPI:1225015720
Name:ALBAUGH, RICKEY D (RN, CRNA)
Entity Type:Individual
Prefix:
First Name:RICKEY
Middle Name:D
Last Name:ALBAUGH
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Gender:M
Credentials:RN, CRNA
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Mailing Address - Street 1:3045 S NATIONAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4247
Mailing Address - Country:US
Mailing Address - Phone:417-882-1900
Mailing Address - Fax:417-882-1966
Practice Address - Street 1:3045 S NATIONAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4247
Practice Address - Country:US
Practice Address - Phone:417-882-1900
Practice Address - Fax:417-882-1966
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-11-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO058813367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO058813OtherSTATE LICENSE