Provider Demographics
NPI:1982650784
Name:KUTTERER, BRENDA SUE (CRNA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:KUTTERER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:SUE
Other - Last Name:MCCRARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7800 COLLEGE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1992
Mailing Address - Country:US
Mailing Address - Phone:913-491-3999
Mailing Address - Fax:913-491-9309
Practice Address - Street 1:8101 W 135TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-1111
Practice Address - Country:US
Practice Address - Phone:913-491-3999
Practice Address - Fax:913-491-9309
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO083335367500000X
KS14-61682-011367500000X
TXAP130836367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200347390AMedicaid
MO917403909Medicaid
KS200347390DMedicaid
MO452E118Medicare PIN
MOP00326812Medicare PIN
KS200347390DMedicaid