Provider Demographics
NPI:1265408595
Name:MCCONNAUGHHAY, ANN RENNE (CRNA)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:RENNE
Last Name:MCCONNAUGHHAY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:RENNE
Other - Last Name:BREDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:8717 W 110TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2144
Mailing Address - Country:US
Mailing Address - Phone:913-428-2910
Mailing Address - Fax:913-428-2951
Practice Address - Street 1:2100 SE BLUE PKWY
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1007
Practice Address - Country:US
Practice Address - Phone:913-428-2900
Practice Address - Fax:913-428-2951
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000166074367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO013B00057OtherMEDICARE
MO013000122OtherMEDICARE