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credentialing offices

credentialing offices

This page is designed to assist Facility and Staffing Agency Credentialing Offices to verify my credentials and obtain documents.

Please note that, prior to accepting an assignment and beginning the credentialing process, I require signed documentation outlining my expectations. For a summary of my expectations from credentialing personnel, please click . You can view the Engagement Agreement for a full list of my expectations and who signs it.

Due to the extensive amount of data in this section, some documents and information will only display on wider viewports. To access all available information, please view in landscape mode on tablets or larger devices.
Case Logs
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I've compiled my case logs from the various facilities by the facility and dates of service chronologically. Each facility reports differently and often times I only receive an Excel spreadsheet in lieu of a more professional account. The pertinent information is displayed relative to the viewport of your device. Click on the View Cases buttons that correspond to the Facility for a printable/downloadable pdf file.

Facility Dates of Service Case Log Document
Canyon Vista Medical Center, Sierra Vista, AZ 04/15/2019 - 05/10/2019
Dartmouth-Hitchcock Medical Center, Lebanon, NH 08/13/2018 - 02/28/2019
St. David's North and South Medical Centers, Austin, TX 04/09/2018 - 06/15/2018
Hunt Regional Medical Center, Greenville, TX 12/11/2017 - 04/06/2018
Concord Hospital, Concord, NH 09/01/2017 - 11/01/2017
Banner University Medical Center, Tuscon, AZ 04/03/2017 - 07/28/2017 Currently Unavailable
Fairbanks Memorial Hosptial, Fairbanks, AK 10/24/2016 - 02/12/2017 05/02/2016 - 06/14/2016
Baystate Medical Center, Springfield, MA 06/20/2016 - 09/16/2016
Texas Tech University Health Sciences Center, Lubbock, TX 12/14/2015 - 03/04/2016
Certifications
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NBCRNA
Certification # Type Exp. Date
74273 Board 07/31/2020
BLS
Certification # Type Exp. Date
N/A CEU 07/29/2021
ACLS
Certification # Type Exp. Date
N/A CEU 01/01/2021
PALS
Certification # Type Exp. Date
N/A CEU 04/30/2021
AANA
Certification # Type Exp. Date
74273 Membership 08/31/2019
DEA
Certification # Type Exp. Date
MC294224 License 08/31/2022
NPPES
Certification # Type Exp. Date
NPI 1861437337 Provider Number N/A
CEU's
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My current CPC cycle is from 8/1/2016 through 7/31/2020.
I currently have 104 Class A credits and 10 Class B credits. To view a current downloadable / printable AANA CPC Transcript click on this button.  

For more details on course work and credits earned, click on the View Report buttons that correspond with the descriptions.

Dates Acquired Description Certificate
08/01/2018 - 07/31/2019 Frank Moya Credits Earned
09/21/2018 - 02/25/2019 Transcript Report
01/30/2019 Class B - Discovery
08/01/2017 - 07/31/2018 Frank Moya Credits Earned
08/01/2016 - 07/31/2017 Frank Moya Credits Earned
CV-Curriculum Vitae
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Click on the button to view or download a copy of my CV.      

Education - University
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Below are the educational institutions I attended.

College / University Degree Date Graduated
Texas Wesleyan University M.S. Nurse Anesthesia Dec 2005
University of Texas at Austin Ph.D. Nutritional Science May 1996
University of New York at Potsdam B.A. Biology Dec 1986
SUNY Agricultural and Technical College A.S. Nursing May 1983
Employment History
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Facility City / State Start / End
Central Peninsula Hosptial Soldotna, AK 07/29/2019 to present
Fairbanks Memorial Hospital Fairbanks, AK 05/20/2019 to 7/19/2019
Canyon Vista Medical Center Sierra Vista, AZ 04/15/2019 thru 05/10/2019
Dartmouth-Hitchcock Medical Center Lebanon, NH 08/13/2018 thru 02/28/2019
St. David's Medical Centers Austin (Metro Area), TX 04/09/2018 thru 06/15/2018
Hunt Regional Medical Center Greenville, TX 12/11/2017 thru 04/06/2018
Concord Hospital Concord, NH 09/01/2017 thru 11/01/2017
Banner University Medical Center Tucson, AZ 04/03/2017 thru 07/28/2017
Fairbanks Memorial Hospital Fairbanks, AK 10/24/2016 thru 02/12/2017
Baystate Medical Center Springfield, MA 06/20/2016 thru 09/16/2016
Fairbanks Memorial Hospital Fairbanks, AK 05/02/2016 thru 06/14/2016
Vacation DreamSafe Anesthesia Staffing, Inc. 03/05/2016 thru 05/01/2016
Texas Tech University Health Sciences Center Lubbock, TX 12/14/2015 thru 03/04/2016
PeaceHealth Ketchikan Medical Center Ketchikan, AK 09/01/2014 thru 11/15/2015
Vacation DreamSafe Anesthesia Staffing, Inc. 07/01/2014 thru 08/31/2014
Kaiser Permanente Seattle & Tacoma, WA 09/01/2013 thru 06/30/2014
VA Anchorage Anchorage, AK 05/29/2012 thru 09/30/2013
Creekside Surgery Center Anchorage, AK 04/01/2012 thru 06/30/2012
Mat-Su Regional Medical Center Palmer, AK 08/01/2011 thru 04/05/2012
Creekside Surgery Center Anchorage, AK 06/01/2011 thru 12/30/2011
Alaska Surgery Center Anchorage, AK 03/14/2011 thru 06/01/2011
Petersburg Medical Center Petersburg, AK 03/01/2011 thru 12/31/2011
Relocated to AK DreamSafe Anesthesia Staffing, Inc. 11/01/2010 thru 03/13/2011
Lakewood Endoscopy Center Lakewood, CO 01/18/2010 thru 10/30/2010
Covenant SurgiCenter Lubbock, TX 09/15/2008 thru 01/15/2010
Oklahoma University Health Sciences Center Oklahoma City, OK 07/14/2008 thru 09/11/2008
Texas Tech University Health Sciences Center Lubbock, TX 01/01/2006 thru 07/10/2008
Health Records
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I maintain documented proof of current immunization records for the below list of vaccines.

A User ID and Password are required to view and download a copy of my health records. To request a User ID and Password click HERE.

  • Seasonal Influenza
  • Tetanus, Diphtheria, and Pertussis (Tdap)
  • Tuberculosis (PPD)
  • Measles, Mumps, Rubella (MMR)
  • Varicella
  • Hepatitis B

Click here to view and download a current copy of my health records.     



Hospital Affliations
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Below are the facilities where I have credentialed. Those that are active are where I have maintained my privileges.

Facility Status
Central Peninsula General Hospital - AK Active
Fairbanks Memorial Hospital - AK Temporary Privileges
Canyon Vista Medical Center - AZ Inactive
Dartmouth-Hitchcock - NH Active
St. David's Medical Centers - TX Inactive
Hunt Regional Medical Center - TX Active
Concord Hospital - NH Active
Banner University Medical Center - AZ Inactive
Baystate Medical Center - MA Inactive
Texas Tech University Health Sciences Center - TX Inactive
PeaceHealth Ketchikan Medical Center - AK Inactive
Kaiser Permanente- WA Inactive
Alaska Veteran's Administration Anchorage- AK Inactive
Creekside Surgery Center - AK Active
Mat-Su Regional Medical Center - AK Inactive
Alaska Surgery Center - AK Inactive
Petersburg Medical Center - AK Inactive
Lakewood Endoscopy Center - CO Inactive
Covenant SurgiCenter - TX Inactive
Oklahoma University Health Sciences Center - OK Inactive
Liability Insurance
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I have carried my own liability insurance with AANA Insurance Services every year since 2008 in addition to being insured separately by staffing agencies. In my entire career, my insurance has not been terminated nor have I been denied coverage or been the subject of any professional liability claims or suits.

Licenses
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The table below represents all of my Active and Inactive RN and APN licenses. Links to the right provide online verification.

Alabama
License # Type Exp. Date
1-173055 RN 12/31/2020
1-173055 CRNA 07/31/2020
Alaska
License # Type Exp. Date
NURA371 APN 11/30/2020
RN-NURR31798 RN 11/30/2020
MC2942224 DEA 08/31/2022
Arizona
License # Type Exp. Date
CRNA1391 CRNA 04/01/2021
RN064542 RN 04/01/2021
Georgia
License # Type Exp. Date
RN285400 RN 01/31/2021
RN285400 APRN-CRNA 01/31/2021
Massachusetts
License # Type Exp. Date
RN190395 APRN 04/20/2020
RN190395 RN 04/20/2020
New Hampshire
License # Type Exp. Date
028281-21 RN 04/20/2021
028281-23 APRN-CRNA 04/20/2021
New York
License # Type Exp. Date
358310 RN 03/31/2022
Texas
License # Type Exp. Date
AP114714 APRN 04/30/2021
587365 RN 04/30/2021
Washington
License # Type Exp. Date
AP60406864 APRN 04/20/2020
RN60406867 RN 04/20/2020
Colorado
License # Type Exp. Date
0025015 RN-APRN Inactive
Oklahoma
License # Type Exp. Date
93350 RN-APRN 04/30/2015
Virginia
License # Type Exp. Date
0001236197 RN 04/30/2013
References
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Below is a list of my colleagues who have provided references for me in the past. Please let me know what you require with respect to:

  • Number of MD’s
  • Number of CRNA's
  • Maximum length of time since working together

I will send you the respective phone numbers and email addresses for those contacts provided:

  • All other credentialing materials are in place and verified and/or
  • It is 3 weeks prior to the assignment start date.

As a Traveler, I often need to request references multiple times from the same MD’s & CRNA’s. This can become a burden on my colleagues, especially if these requests come without my knowing that they have been sent. That said, I respectfully request that you AGREE to contact my references within 24 hours after receipt of their information. That way I can personally let them know you will be contacting them and to respond promptly.

Name / Title Role Worked Together In:
Andy Lester, MD Anesthesiologist 2019
Nicole Bonfoey, CRNA CRNA
Lola Wise, MD Anesthesiologist 2019
Roshoyah "Ro" Bernard, CRNA CRNA 2019
Corey Burchman, MD Anesthesiologist
Dan Moses, CRNA Chief CRNA 2018
Nkosiyalinda "Kosi" Dube, CRNA Chief CRNA 2018
Richard Loeffler CRNA CRNA
Romeo Baltazar, MD Anesthesiologist
Sue Schultz, MD Anesthesiologist 2017
Thomas Pedersen, MD Anesthesiologist
Martha Fielder, MD Anesthesiologist 2017
Ravonne Ross, CRNA, ARNP CRNA
Ann Patterson, MD Anesthesiologist 2017
Christopher Burns, CRNA CRNA
William Quirk, MD Anesthesiologist
Christopher Dow, MD Anesthesiologist 2016
Mark Falvey, CRNA Chief CRNA
Ron Banister, MD Anesthesiologist 2016
Sue Holland, CRNA (Ret.) CRNA
Credentialing a locum is an arduous job. I have made every effort to make your job easier. Over the years I've been asked to provide a wide array of documentation. Hopefully whatever you require can be located here on this page.

For example, by pressing the VERIFY buttons in the Employment History and Hospital Affiliations sections, popups display all verification information and more.

I invite your to explore this page. Use the vertical menu to locate the information you require. Note that this is ordered alphabetically and not ordered how the application would be.

Click  HERE to request any or all of the following:

  • UserID and Password for protected documents
  • Contact details for Peer and MD References
  • Additional documentation requests
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Credentials