PHYLLIS KNICKERBOCKER


Address: 2727 Mcclelland Blvd, Joplin, MO 64804-1626
Phone: 4177812727

PHYLLIS KNICKERBOCKER (NPI# 1528035144) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1528035144
Entity Type Individual
Full Name PHYLLIS KNICKERBOCKER
Credential CRNA
Practice Address 2727 Mcclelland Blvd
Joplin
MO 64804-1626
Mailing Address Po Box 760
Joplin
MO 64802-0760
Practice Telephone 4177812727
Practice Fax Number 3166520340
Mailing Telephone 4176243040
Mailing Fax Number 3166520340
Enumeration Date 2006-03-02
Last Update Date 2007-07-08
Gender Code F
Is Sole Proprietor X

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 367500000X Nurse Anesthetist, Certified Registered 1999137827 MO Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
MO BCBS 108602A 01

Office Location

Street Address 2727 MCCLELLAND BLVD
City JOPLIN
State MO
Zip Code 64804-1626

Providers in the same location

NPI Name Taxonomy Address Enumeration
1174812523 St John's Regional Medical Center General Acute Care Hospital 2727 Mcclelland Blvd, Wound Care, Joplin, MO 64804-1626 2011-04-06
1962702225 Joplin Pathology Professionals PC Pathology 2727 Mcclelland Blvd, St. John's Regional Med Ctr Pathology Dept, Joplin, MO 64804-1626 2010-11-02
1992015176 Sandi Boyce Speech-Language Pathologist 2727 Mcclelland Blvd, Joplin, MO 64804-1626 2010-10-20
1376862979 Magen Combs Physical Therapist 2727 Mcclelland Blvd, Joplin, MO 64804-1626 2010-05-20
1124345509 Carol Watts Physical Therapist 2727 Mcclelland Blvd, Joplin, MO 64804-1626 2010-04-26
1265766075 Dawnya Mae Gibbs Occupational Therapist 2727 Mcclelland Blvd, Joplin, MO 64804-1626 2009-09-25
1043443914 Rachel Lynn Morgan Occupational Therapist 2727 Mcclelland Blvd, Joplin, MO 64804-1626 2009-08-26
1366677072 Robert Dale Mcdermid Psychologist 2727 Mcclelland Blvd, Joplin, MO 64804-1626 2009-05-26
1013150556 Debra Hamilton Registered Nurse 2727 Mcclelland Blvd, Joplin, MO 64804-1626 2009-04-14
1528206893 Ryan Palmer Emergency Medical Technician, Basic 2727 Mcclelland Blvd, Joplin, MO 64804-1626 2009-01-25
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1033718903 Lisa Jo Moore Nurse Practitioner 2623 S Main Street, Nixa, MO 64804 2020-10-22
1346859600 Centered and Connected LLC Counselor 2401 E 32nd St, Ste 10 #103, Joplin, MO 64804 2020-07-23
1649838780 Nicole Lynn Egan Social Worker 3010 Mcclelland, Joplin, MO 64804 2019-06-04
1902361652 Redings Mill Internal Care Clinic/Center 454 Redings Mill Rd, Joplin, MO 64804 2019-02-06
1447732508 Urgent Care Travel, Inc Clinic/Center 5931 E 32nd Street, Joplin, MO 64804 2018-09-05
1912488891 Karl G. Keczkemethy Dietitian, Registered 100 Mercy Way Ste 570, Joplin, MO 64804 2018-08-28
1790207546 Jacksie Short Dentist 2819 E 29th St, Joplin, MO 64804 2017-07-13
1326574625 Kristine Kwon Rowland Nurse Practitioner 100 Mercy Way Ste 320-330, Joplin, MO 64804 2017-05-05
1942735212 West R Loveland Counselor 3230 S Wisconsin St Suite H, Joplin, MO 64804 2017-04-25
1174070205 Tracy L Fry Nurse Practitioner 3333 Mcintosh Cir Ste 4, Joplin, MO 64804 2016-09-07
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Taxonomy Information

Taxonomy Code 367500000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Anesthetist, Certified Registered

Taxonomy Definition

(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1689108839 Todd Aaron Macdonald Nurse Anesthetist, Certified Registered 2119 Highlander Dr, Joplin, MO 64804-7005 2017-04-14
1659635217 Neal R. Popichak Nurse Anesthetist, Certified Registered 102 West 32nd St., Joplin, MO 64804-0000 2012-06-28
1295046720 Wayne R Alongi Nurse Anesthetist, Certified Registered 4213 Wisconsin, Joplin, MO 64804-5806 2010-06-30
1851622849 Jessica Louann Rush Nurse Anesthetist, Certified Registered 3522 Norman Dr, Joplin, MO 64804-4057 2010-01-15
1891706776 Heidi Jane Peterson Nurse Anesthetist, Certified Registered 2516 N Ozark Ave, Joplin, MO 64801-4716 2006-08-10
1982650305 Jennifer L Cronenwett Nurse Anesthetist, Certified Registered 1531 E 32nd St Ste 6, Joplin, MO 64804-9810 2006-05-26
1568417517 Curt B Carlisle Nurse Anesthetist, Certified Registered 15 Woodcrest Dr, Joplin, MO 64804-5828 2006-05-24
1255386934 Robert Eugene Mccain Nurse Anesthetist, Certified Registered 1102 West 32nd Street, Joplin, MO 64804 2006-05-23
1336193622 Carolyn Elmborg Nurse Anesthetist, Certified Registered 5752 Ridge Trl, Joplin, MO 64804-9506 2006-05-20
1053382929 Four States Anesthesia Services LLC Nurse Anesthetist, Certified Registered 1905 West 32nd Street, Suite #201, Joplin, MO 64804 2006-01-30
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City JOPLIN
Zip Code 64804

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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