Provider Demographics
NPI:1780785741
Name:QUICK, STACEY ANN (CRNA)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANN
Last Name:QUICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:QUARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5830 NW BARRY RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-2778
Mailing Address - Country:US
Mailing Address - Phone:816-880-6444
Mailing Address - Fax:816-880-6740
Practice Address - Street 1:5830 NW BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-2778
Practice Address - Country:US
Practice Address - Phone:816-880-6444
Practice Address - Fax:816-880-6740
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003016623367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1780785741Medicaid
MO910910504Medicaid
KS200688360AMedicaid
MOP00914781OtherRR MEDICARE
KS200688360AMedicaid
MOK98000007Medicare PIN
Q69311Medicare UPIN