Provider Demographics
NPI:1891793238
Name:CAST, LISA KATHLEEN (CRNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KATHLEEN
Last Name:CAST
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:RR 2 BOX 300A
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MO
Mailing Address - Zip Code:64673-9467
Mailing Address - Country:US
Mailing Address - Phone:660-748-4396
Mailing Address - Fax:660-748-4398
Practice Address - Street 1:1000 CARONDELET DR
Practice Address - Street 2:SAINT JOSEPH HEALTH CENTER
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4673
Practice Address - Country:US
Practice Address - Phone:816-943-2252
Practice Address - Fax:816-943-4656
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO083049367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200355240AMedicaid
KS22267044OtherBCBS
KSP00102707OtherRAILROAD
KS200355240AMedicaid