Provider Demographics
NPI:1407846454
Name:GAINES, CHERYL L (CRNA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:GAINES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SWIFT AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3445
Mailing Address - Country:US
Mailing Address - Phone:816-221-5050
Mailing Address - Fax:816-471-1247
Practice Address - Street 1:2800 CLAY EDWARDS DR
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3220
Practice Address - Country:US
Practice Address - Phone:816-221-5050
Practice Address - Fax:816-471-1247
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010021175367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00937035OtherMEDICARE RAILROAD
FL304382700Medicaid
FL430027986OtherMCRR
FLG1400OtherBSFL
FLG1400ZOtherMCR
MOH900000016OtherMEDICARE