Provider Demographics
NPI:1396704052
Name:BEATH-HOOGHEEM, PATRICIA JEAN (CRNA BS)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JEAN
Last Name:BEATH-HOOGHEEM
Suffix:
Gender:F
Credentials:CRNA BS
Other - Prefix:
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Mailing Address - Street 1:131 S DARTMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-3023
Mailing Address - Country:US
Mailing Address - Phone:785-776-6155
Mailing Address - Fax:785-776-3115
Practice Address - Street 1:1929 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3382
Practice Address - Country:US
Practice Address - Phone:785-776-5100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS54158367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS9159718501Medicaid
KS9159718501Medicaid