Healthcare Provider Details

I. General information

NPI: 1972032035
Provider Name (Legal Business Name): ANTHONY TRAVIS THROWER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 W 32ND ST
JOPLIN MO
64804-3503
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-6671
  • Fax: 417-347-0131
Mailing address:
  • Phone: 417-347-8400
  • Fax: 417-347-5818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2017018177
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: