Provider Demographics
NPI:1760709836
Name:SIMPELO CAIN, THERESA L (CRNA)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:SIMPELO CAIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:L
Other - Last Name:SIMPELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 SWIFT AVE STE 203
Mailing Address - Street 2:P O BOX 7391
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3400
Mailing Address - Country:US
Mailing Address - Phone:816-221-5050
Mailing Address - Fax:816-471-1247
Practice Address - Street 1:2800 CLAY EDWARDS DR
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3220
Practice Address - Country:US
Practice Address - Phone:816-221-5050
Practice Address - Fax:816-471-1247
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO132225163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH90000010Medicare PIN