Provider Demographics
NPI:1619078664
Name:CLEMENTS, MICHELE LEIGH (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LEIGH
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:LEIGH
Other - Last Name:CLEMENTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:9386 LIME STONE RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-3169
Mailing Address - Country:US
Mailing Address - Phone:816-914-3142
Mailing Address - Fax:816-321-2716
Practice Address - Street 1:2700 CLAY EDWARDS DR STE 240
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3254
Practice Address - Country:US
Practice Address - Phone:816-691-2021
Practice Address - Fax:816-346-7690
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO095695367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO919993709Medicaid