Healthcare Provider Details

I. General information

NPI: 1174946610
Provider Name (Legal Business Name): RACHEL ANN EVANS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL JACKMAN CRNA

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 PORTLAND ST STE 100
COLUMBIA MO
65201-6677
US

IV. Provider business mailing address

210 PORTLAND ST STE 100
COLUMBIA MO
65201-6677
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-8818
  • Fax: 573-777-8819
Mailing address:
  • Phone: 573-777-8818
  • Fax: 573-777-8819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD185395
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2014005782
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: