Provider Demographics
NPI:1720017296
Name:CROSNOE, JANNA R (MD)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:R
Last Name:CROSNOE
Suffix:
Gender:F
Credentials:MD
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 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:1702 N KINGSHIGHWAY ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2122
Practice Address - Country:US
Practice Address - Phone:573-339-0483
Practice Address - Fax:573-339-1876
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD106393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
333547OtherHEALTHLINK
MO208668004Medicaid
MO603526OtherANTHEM BCBS
MOP00779915OtherRR MCR
MOP00779915OtherRR MCR
333547OtherHEALTHLINK
MO030010653Medicare PIN