Provider Demographics
NPI:1659401198
Name:SUMMERS, JOANNIE R (CRNA)
Entity Type:Individual
Prefix:
First Name:JOANNIE
Middle Name:R
Last Name:SUMMERS
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 1547
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65302-1547
Mailing Address - Country:US
Mailing Address - Phone:660-826-5960
Mailing Address - Fax:660-826-4852
Practice Address - Street 1:3310 ASPEN GROVE DR STE 203
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2852
Practice Address - Country:US
Practice Address - Phone:615-430-0364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11432367500000X
TN118730163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3635427Medicaid
AL009933779Medicaid
TN4114044OtherBCBS
TN4222379OtherBLUE CROSS/BLUE SHIELD OF TN
KY74010349Medicaid
TNP00737377OtherRR MEDICARE
TNP00737377OtherRR MEDICARE