Provider Demographics
NPI:1134189921
Name:WILSON, CHRISTOPHER (CRNA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 N 139TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-4234
Mailing Address - Country:US
Mailing Address - Phone:913-721-3641
Mailing Address - Fax:913-721-3649
Practice Address - Street 1:4510 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3238
Practice Address - Country:US
Practice Address - Phone:816-364-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO152132367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1797OtherCOMMUNITY HEALTH PLAN
KS16566OtherPREFERRED HEALTH SYSTEMS
KS200538010AMedicaid
KSP00430894OtherRAILROAD MEDICARE
MOP00435048OtherRAILROAD MEDICARE
MO2609/023OtherBLUE CROSS BLUE SHIELD KANSAS CITY
66048A018OtherTRICARE WPS
MO913879607Medicaid
MOB668577BMedicare PIN
KSP00430894OtherRAILROAD MEDICARE
MO1797OtherCOMMUNITY HEALTH PLAN
MOP00435048OtherRAILROAD MEDICARE
KS200538010AMedicaid
MOW498577AMedicare PIN