Healthcare Provider Details

I. General information

NPI: 1942588678
Provider Name (Legal Business Name): CASEY LYNN MILLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASEY LYNN MALONEY

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CLAYTON COURT DR
SAINT LOUIS MO
63131-2524
US

IV. Provider business mailing address

44 SPRING TRAIL CT
SAINT CHARLES MO
63303-6488
US

V. Phone/Fax

Practice location:
  • Phone: 314-495-6037
  • Fax:
Mailing address:
  • Phone: 573-280-9998
  • Fax: 618-208-7384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2011022107
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: