Healthcare Provider Details

I. General information

NPI: 1225290828
Provider Name (Legal Business Name): JASON ANTHONY COREY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65212-0001
US

IV. Provider business mailing address

PO BOX 220
ROLLA MO
65402-0220
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-2568
  • Fax: 855-903-0985
Mailing address:
  • Phone: 573-458-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2001019116
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: