Provider Demographics
NPI:1134378821
Name:MICHAELSON, JILL ELIZABETH (CRNA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ELIZABETH
Last Name:MICHAELSON
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ELIZABETH
Other - Last Name:MELLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
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:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:ONE 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:573-882-2568
Practice Address - Fax:573-882-2226
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO155500367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178220001Medicaid
MO1134378821Medicaid
431560263OtherTRICARE WEST
431560263OtherTRICARE WEST