Judith Anne Moran, C.R.N.A.

Key facts

NPI

1710971908

Entity type

Individual (NPI type 1)

Primary specialty

Certified Registered Nurse Anesthetist 367500000X

License

128948 (MO)

Practice address

10010 Kennerly Rd
Saint Louis, MO 63128-2106

Phone

(636) 386-7222

Fax

(636) 386-7810

NPI assigned

Sep 2, 2005

Sex

Female

Sole proprietor

No

Organizations & group practices 1

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.

• Lake of the Ozarks Pain Management Services, Inc Specialist · Osage Beach, MO · NPI 1003901976
  NPD (past) NURSE ANESTHETIST, CERTIFIED REGISTERED

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Certified Registered Nurse

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 12, 2016.

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455235200000",
    "number": "1710971908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22407",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631260407",
            "telephone_number": "636-386-7222",
            "fax_number": "636-386-7810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10010 KENNERLY RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282106",
            "telephone_number": "636-386-7222",
            "fax_number": "636-386-7810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORAN",
        "first_name": "JUDITH",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "C.R.N.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-02",
        "last_updated": "2016-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "C01016",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "APN0000010072",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "128948",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143653701",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS TN PROV #",
            "identifier": "4068895",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3629651",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "911331007",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "900418777",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AR PROV #",
            "identifier": "5T743",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

• Andre Michael Morales, MD
• Angelina Grace Morales
• Amy Elizabeth Moran, AGPCNP-BC
• Eleanor Rose Moran, QMHP, LPC (IL), PLPC
• John Moran, CRNA
• Kathryn Moran, PT
• Lauren Moran, NP
• Lauren Rogowski Moran, MD
• Ryleigh Moran
• Stephanie Lauren Moran, M.S. SLP-CF

All providers in Saint Louis, MO · Certified Registered Nurse Anesthetist in Missouri