ANDREA MARIE JACK (NPI# 1538239850) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538239850 |
| Entity Type | Individual |
| Full Name | ANDREA MARIE JACK |
| Other Name | ANDREA MARIE GIBSON |
| Credential | CRNA |
| Practice Address |
224 E Douglas Ave Suite 400 Wichita KS 67202-3423 |
| Mailing Address |
Po Box 2897 Wichita KS 67201-2897 |
| Practice Telephone | 3162641757 |
| Practice Fax Number | 3162641907 |
| Mailing Telephone | 8003745326 |
| Mailing Fax Number | 8003747656 |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2008-03-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | 55536 | KS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | BCBS OF KS | 145392 | 01 |
| RR MEDICARE GROUP CQ2302 | P00398985 | 01 |
| Street Address |
224 E DOUGLAS AVE SUITE 400 |
| City | WICHITA |
| State | KS |
| Zip Code | 67202-3423 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245845338 | Raneisha Hunter | Marriage & Family Therapist | 622 E. Douglasave, Wichita, KS 67202 | 2020-09-15 |
| 1104397124 | Bridges Healthcare Inc | Clinic/Center | 313 S. Market Street, Wichita, KS 67202 | 2018-12-17 |
| 1043712912 | Creative Bliss Therapy | Counselor | 115 Waterman Street, Wichita, KS 67202 | 2018-03-06 |
| 1720596240 | Sunheart Holistic, LLC | Social Worker | 200 N Broadway Ave Ste 535, Wichita, KS 67202 | 2018-01-18 |
| 1912423823 | Jenni Harshbarger, Phd, P.a. | Clinic/Center | 801 E. Douglas, Regus Suites, 2nd Floor, Wichita, KS 67202 | 2017-08-22 |
| 1336695287 | The Young Men's Christian Association of Wichita, Kansas | Health Educator | 402 N Market St, Wichita, KS 67202 | 2016-08-31 |
| 1699103739 | Nadine Reimer Penner | Social Worker | 313 S Market Street, Wichita, KS 67202 | 2013-10-29 |
| 1386992691 | Andrea Lynn Kasper-doggett | Social Worker | 100 S Market St Ste 2a, Wichita, KS 67202 | 2012-08-16 |
| 1679883318 | Carol Ann Knott | Registered Nurse | 909 N. Emporia, Wichita, KS 67202 | 2010-10-15 |
| 1851539431 | Peter Anthony Conrardy | Anesthesiology | 224 E. Douglas Ave., Suite 400 C/o Anesthesia Consulting Services, Wichita, KS 67202 | 2009-02-04 |
| Find all providers in zip 67202 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (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. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245740018 | Kansas Endoscopy LLC | Nurse Anesthetist, Certified Registered | 3121 N Webb Rd Ste 107, Wichita, KS 67226-8119 | 2017-10-06 |
| 1467755413 | Tamara Lynette Rothenberger | Nurse Anesthetist, Certified Registered | 1515 S Clifton Ave Ste 200, Wichita, KS 67218-2958 | 2010-12-14 |
| 1285966689 | Ryan Vincent Berland | Nurse Anesthetist, Certified Registered | 11628 W Nantucket St, Wichita, KS 67212-6938 | 2010-02-10 |
| 1528226206 | Amy Michelle King | Nurse Anesthetist, Certified Registered | 556 N Oakwood Dr, Wichita, KS 67208-4227 | 2008-05-29 |
| 1013100221 | Janet L Miller | Nurse Anesthetist, Certified Registered | 3450 N Rock Rd Ste 208, Wichita, KS 67226-1352 | 2007-08-21 |
| 1316957780 | Mary Leahy | Nurse Anesthetist, Certified Registered | 731 N Mclean Blvd, Wichita, KS 67203-4986 | 2006-08-09 |
| 1013952126 | Ophthalmic Anesthesia Team Pa | Nurse Anesthetist, Certified Registered | 6100 East Central, Ste 5, Wichita, KS 67212 | 2006-06-20 |
| 1699719393 | David Milton Adamson | Nurse Anesthetist, Certified Registered | 5800 East Kellogg Ave, Bob Dole Va Hospital, Wichita, KS 67218 | 2006-06-15 |
| 1003853300 | Jill C Gallagher | Nurse Anesthetist, Certified Registered | 8330 E Overbrook St, Wichita, KS 67206-2326 | 2006-06-02 |
| 1013961804 | Brian Lee Moore | Nurse Anesthetist, Certified Registered | 6615 Briarwood Cir, Wichita, KS 67212-2986 | 2006-05-19 |
| Find all providers in WICHITA | ||||
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| 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.