Basic Information
Provider Information | |||||||||
NPI: | 1972243442 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ADAIR | ||||||||
FirstName: | SHANNON | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 412431 | ||||||||
Address2: |   | ||||||||
City: | KANSAS CITY | ||||||||
State: | MO | ||||||||
PostalCode: | 641412431 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9136474100 | ||||||||
FaxNumber: | 9136474120 | ||||||||
Practice Location | |||||||||
Address1: | 100 NE SAINT LUKES BLVD | ||||||||
Address2: |   | ||||||||
City: | LEES SUMMIT | ||||||||
State: | MO | ||||||||
PostalCode: | 640866000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8163475097 | ||||||||
FaxNumber: | 8163475045 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/31/2022 | ||||||||
LastUpdateDate: | 05/31/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/31/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 2014020259 | MO | N |   | Nursing Service Providers | Registered Nurse |   | 367500000X | 2022018936 | MO | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.