Provider Demographics
NPI:1437118056
Name:JESTER, TRICIA H (CRNA)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:H
Last Name:JESTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 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:816-880-6021
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:816-880-6021
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO091358367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100396710BMedicaid
MO919703827Medicaid
MOP00397073OtherRR MEDICARE
MO4526788Medicare ID - Type Unspecified
KS100396710BMedicaid
MOS60281Medicare UPIN