Provider Demographics
NPI:1477656957
Name:GERAGHTY, JUDITH S (CRNA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:S
Last Name:GERAGHTY
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 1:940 WEST PORT PLAZA
Mailing Address - Street 2:STE 270
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146
Mailing Address - Country:US
Mailing Address - Phone:314-453-0600
Mailing Address - Fax:314-453-0083
Practice Address - Street 1:1800 EAST MEYER BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132
Practice Address - Country:US
Practice Address - Phone:816-523-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO061979367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO124236Medicare ID - Type Unspecified