Active NPI
Mallory Elizabeth Stith, CRNA
- Certified Registered Nurse Anesthetist
- Kennett, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 2016005888
- Practice address
- 1301 1St St
Kennett, MO 63857-2525 - Phone
- (573) 718-4038
- NPI assigned
- Feb 25, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 2016005888 | MO | Primary |
Addresses
Primary practice location
1301 1St St
Kennett, MO 63857-2525
Mailing address
40 Kathy CV
Poplar Bluff, MO 63901-2095
Phone (573) 718-4038
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2620 N Westwood Blvd
Poplar Bluff, MO 63901-3396
Phone (901) 682-6828
3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573
Phone (901) 682-6828
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2016005888 | MO | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Health Center of Stoddard County, LLC | Current | Accepting new patients | |
| Southeast Health Center of Stoddard County LLC | Current | Accepting new patients | |
| Capital Anesthesia Solutions of Missouri, LLC | Current | Accepting new patients | |
| Rural Health Pain Management LLC | Current | Accepting new patients | |
| Clinical Colleagues Inc | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
Locations
1200 N One Mile Rd
Dexter, MO 63841
Phone (573) 614-1900
1515 Union Ave
Moberly, MO 65270
Phone (660) 263-2400
2620 N Westwood Blvd
Poplar Bluff, MO 63901
Phone (573) 686-4111
3100 Oak Grove Rd
Rombauer, MO 63901
Phone (573) 776-2000
Organizations & group practices 6
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.
-
- Pain Medicine (Anesthesiology) Physician
- Forrest City, AR
- NPI 1265039556
MO
-
- Anesthesiology Physician
- Rombauer, MO
- NPI 1770185472
-
- Anesthesiology Physician
- Van Wert, OH
- NPI 1992725766
MO, Nurse Anesthetist, Certified Registered
-
- Rural Health Clinic/Center
- Dexter, MO
- NPI 1790828812
-
- Family Medicine Physician
- Dexter, MO
- NPI 1477997567
-
- Rural Health Clinic/Center
- Dexter, MO
- NPI 1457660045
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Poplar Bluff, MO
- NPI 1700831724
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456358400000",
"number": "1639539141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 KATHY CV",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639012095",
"telephone_number": "573-718-4038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 1ST ST",
"city": "KENNETT",
"state": "MO",
"postal_code": "638572525",
"telephone_number": "573-718-4038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STITH",
"first_name": "MALLORY",
"middle_name": "ELIZABETH",
"credential": "CRNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-25",
"last_updated": "2016-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MO",
"license": "2016005888",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Kennett, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.