Nicole R Hazelwood, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

2002019453 Issued in MO

Practice address

216 Elm St
Jackson, MO 63755-1708

Phone

(573) 576-1903

NPI assigned

Apr 14, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse, Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aim Anesthesia LLC

  • Anesthesiology Physician
  • Bridgetown, MO
  • NPI 1245685601
  Medicare reassignment NPD
• ASC Anesthesia LLC

  • Anesthesiology Physician
  • Cape Girardeau, MO
  • NPI 1740873033
  Medicare reassignment NPD
• Auburn Surgery Center Inc.

  • Ambulatory Surgical Clinic/Center
  • Cape Girardeau, MO
  • NPI 1265431670
  Medicare reassignment NPD
• Iron County Hospital District

  • Critical Access Hospital
  • Pilot Knob, MO
  • NPI 1477648178
  Medicare reassignment NPD
• Pemiscot County Memorial Hospital

  • Emergency Care Clinic/Center
  • Hayti, MO
  • NPI 1578668661
  Medicare reassignment NPD
• Pemiscot County Memorial Hospital

  • Rural Acute Care Hospital
  • Hayti, MO
  • NPI 1437179710
  NPD
• Sluh Anesthesia Physicians, L.L.C.

  • Anesthesiology Physician
  • Saint Louis, MO
  • NPI 1821385493
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1558504076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 ELM ST",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637551708",
            "telephone_number": "573-576-1903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 ELM ST",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637551708",
            "telephone_number": "573-576-1903"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 W Liberty St",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "MO",
            "postal_code": "636401921",
            "country_code": "US",
            "telephone_number": "573-760-8002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAZELWOOD",
        "first_name": "NICOLE",
        "middle_name": "R",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-14",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "041429789",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2002019453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "110375",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00726014",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1101 W Liberty St",
            "city": "Farmington",
            "state": "MO",
            "country_code": "US",
            "postal_code": "636401921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Melissa Lee Hale, MSW, LCSW
• Haley Wills Counseling, LLC
• Christina Diane Hart, PHARMD
• Judy L Hart
• Cathlin Hayes
• Heartland Chiropractic Center LLC
• Heartland Family Physicains Clinic
• Danielle Nicole Heath, FNP-C
• Suzanne Hightower
• Jaclyn Hiter

• Certified Registered Nurse Anesthetist in Jackson, MO
• Providers in Jackson, MO by specialty
• Certified Registered Nurse Anesthetist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.