Healthcare Provider Details

I. General information

NPI: 1720825482
Provider Name (Legal Business Name): JAMES EDWARD MILES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 K66
GALENA KS
66739-4306
US

IV. Provider business mailing address

1506 GOLD DUST DR
WEBB CITY MO
64870-3009
US

V. Phone/Fax

Practice location:
  • Phone: 417-358-8121
  • Fax:
Mailing address:
  • Phone: 417-592-9304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2025016993
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number223143
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number162978
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: