Provider Demographics
NPI:1871530063
Name:EDMONDS, ASHLEY JACKSON (CRNA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JACKSON
Last Name:EDMONDS
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 1:8717 W 110TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2144
Mailing Address - Country:US
Mailing Address - Phone:913-428-2900
Mailing Address - Fax:913-428-2951
Practice Address - Street 1:10500 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2306
Practice Address - Country:US
Practice Address - Phone:913-428-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55540367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS013E855Medicare PIN