Healthcare Provider Details

I. General information

NPI: 1801294830
Provider Name (Legal Business Name): ALECIA BREAKFIELD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N KENTUCKY AVE
WEST PLAINS MO
65775-2029
US

IV. Provider business mailing address

1100 N KENTUCKY AVE
WEST PLAINS MO
65775-2029
US

V. Phone/Fax

Practice location:
  • Phone: 417-256-9111
  • Fax: 417-257-5838
Mailing address:
  • Phone: 417-256-9111
  • Fax: 417-257-5838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28219369
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28219369A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR878783
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2016029498
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: