Provider Demographics
NPI:1306852983
Name:ZUECK, KRISTY ZIMMER (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:ZIMMER
Last Name:ZUECK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:J
Other - Last Name:ZUECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2317 NORTHEASTER CT
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-2578
Mailing Address - Country:US
Mailing Address - Phone:636-296-2370
Mailing Address - Fax:
Practice Address - Street 1:10010 KENNERLY RD
Practice Address - Street 2:DEPARTMENT OF ANESTHESIA
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128
Practice Address - Country:US
Practice Address - Phone:636-386-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO151253367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO430687077013OtherTRICARE
MO918996109Medicaid
MOP00130170Medicare ID - Type UnspecifiedRAILROAD CPIN
MO918996109Medicaid