Provider Demographics
NPI:1679597041
Name:MCKAY, ELISA A (CRNA)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:A
Last Name:MCKAY
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 1:1900 W 55TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:KS
Mailing Address - Zip Code:66208-1160
Mailing Address - Country:US
Mailing Address - Phone:913-262-2277
Mailing Address - Fax:
Practice Address - Street 1:2301 HOLMES ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2640
Practice Address - Country:US
Practice Address - Phone:816-404-1100
Practice Address - Fax:816-404-1103
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO078933367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO914649447Medicaid
KSP00230485OtherRAILROAD MEDICARE
MOP00322736OtherRAILROAD MEDICARE
NEP00104282OtherRAILROAD MEDICARE
KS100418830CMedicaid
KSK158062BMedicare PIN
MO001014488Medicare PIN
KS100418830CMedicaid
NE272601Medicare PIN