Provider Demographics
NPI:1659355683
Name:CHERRY, ALICE K (CRNA)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:K
Last Name:CHERRY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:K
Other - Last Name:BLANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:DEPT OF ANESTHESIOLOGY
Mailing Address - Street 2:3901 RAINBOW BLVD MS 3021
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-6670
Mailing Address - Fax:913-588-3365
Practice Address - Street 1:DEPT OF ANESTHESIOLOGY
Practice Address - Street 2:3901 RAINBOW BLVD MS 3021
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-6670
Practice Address - Fax:913-588-3365
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO072705367500000X
KS55031367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100417140AMedicaid
MO912751229Medicaid
MO013B678Medicare ID - Type Unspecified
KS100417140AMedicaid