Provider Demographics
NPI:1528037074
Name:VAN GUNDY, KIMBERLY K (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:K
Last Name:VAN GUNDY
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 1:3911 W 74TH TER
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-2952
Mailing Address - Country:US
Mailing Address - Phone:913-777-9994
Mailing Address - Fax:
Practice Address - Street 1:3151 NE CARNEGIE DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-3222
Practice Address - Country:US
Practice Address - Phone:816-347-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD085712367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38964OtherBCBS
IAP00206786OtherRAILROAD MEDICARE
IAD085712OtherTRICARE
IAI15187Medicare ID - Type Unspecified
IA245065OtherMIDLANDS CHOICE