Healthcare Provider Details

I. General information

NPI: 1285636803
Provider Name (Legal Business Name): RICHARD C. WORLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OLD MILL CIR
JOPLIN MO
64804-5804
US

IV. Provider business mailing address

1 OLD MILL CIR
JOPLIN MO
64804-5804
US

V. Phone/Fax

Practice location:
  • Phone: 417-437-2712
  • Fax: 417-627-0130
Mailing address:
  • Phone: 417-437-2712
  • Fax: 417-627-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number111469
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCO1214
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55052
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0073155
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: