Healthcare Provider Details

I. General information

NPI: 1184747545
Provider Name (Legal Business Name): DARLA LASTERS BROWN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 HOSPITAL DR
OSAGE BEACH MO
65065-3050
US

IV. Provider business mailing address

775 GRAND VIEW DR
SUNRISE BEACH MO
65079-5432
US

V. Phone/Fax

Practice location:
  • Phone: 573-348-8000
  • Fax:
Mailing address:
  • Phone: 573-382-0452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number104064
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3009766
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: