Provider Demographics
NPI:1851614838
Name:KAISER, CONNIE JOHANNA (AHCNS)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:JOHANNA
Last Name:KAISER
Suffix:
Gender:F
Credentials:AHCNS
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:JOHANNA
Other - Last Name:SIDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-882-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-2090
Practice Address - Fax:573-884-4205
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010006304364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152360237Medicare PIN