Healthcare Provider Details

I. General information

NPI: 1639193865
Provider Name (Legal Business Name): DARRELL EUGENE MEREDITH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PORTER AVE
AURORA MO
65605-2365
US

IV. Provider business mailing address

901 L C ROBINSON ST
AURORA MO
65605-2582
US

V. Phone/Fax

Practice location:
  • Phone: 417-678-2122
  • Fax:
Mailing address:
  • Phone: 417-678-0261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number141567
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: