Healthcare Provider Details

I. General information

NPI: 1649535402
Provider Name (Legal Business Name): COLE D HUGHES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERCY WAY
JOPLIN MO
64804-4524
US

IV. Provider business mailing address

100 MERCY WAY
JOPLIN MO
64804-4524
US

V. Phone/Fax

Practice location:
  • Phone: 417-556-3570
  • Fax: 417-556-6475
Mailing address:
  • Phone: 417-556-3570
  • Fax: 417-556-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2012022608
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: