Provider Demographics
NPI:1588659684
Name:GIVENS, TERESA K (CRNA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:K
Last Name:GIVENS
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:PO BOX 842120
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-2120
Mailing Address - Country:US
Mailing Address - Phone:417-239-3392
Mailing Address - Fax:417-239-3394
Practice Address - Street 1:251 SKAGGS RD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2031
Practice Address - Country:US
Practice Address - Phone:417-239-3392
Practice Address - Fax:417-239-3394
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109583367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO913567525Medicaid
MO913567525Medicaid