Healthcare Provider Details

I. General information

NPI: 1104898097
Provider Name (Legal Business Name): DARREN ELLIOTT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S KEENE ST
COLUMBIA MO
65201-7199
US

IV. Provider business mailing address

209 S MAIN ST
POPLAR BLUFF MO
63901-5831
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-2402
  • Fax:
Mailing address:
  • Phone: 573-686-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number151060
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: