Provider Demographics
NPI:1740235233
Name:GADBERRY, SCOTT CRAIG (CRNA RN)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:CRAIG
Last Name:GADBERRY
Suffix:
Gender:M
Credentials:CRNA RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 S STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2116
Mailing Address - Country:US
Mailing Address - Phone:417-396-1262
Mailing Address - Fax:
Practice Address - Street 1:1007 S STRATFORD RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-2116
Practice Address - Country:US
Practice Address - Phone:417-396-1262
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO145235367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered