Healthcare Provider Details

I. General information

NPI: 1184081168
Provider Name (Legal Business Name): KATHERINE CAVENDER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E BROADWAY
COLUMBIA MO
65201-5844
US

IV. Provider business mailing address

2102 WHITNEY WOODS DR
JEFFERSON CITY MO
65101-6017
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-8000
  • Fax:
Mailing address:
  • Phone: 573-291-2275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number700821
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: