Healthcare Provider Details

I. General information

NPI: 1053949644
Provider Name (Legal Business Name): JAMES ERIC DAILEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9625
US

IV. Provider business mailing address

PO BOX 804408
KANSAS CITY MO
64180-4408
US

V. Phone/Fax

Practice location:
  • Phone: 816-792-7037
  • Fax: 816-792-7196
Mailing address:
  • Phone: 913-647-4100
  • Fax: 913-647-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2022017507
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: