Healthcare Provider Details

I. General information

NPI: 1689725285
Provider Name (Legal Business Name): STEVEN TIMOTHY MEYER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 DEERFIELD RD
BOONE NC
28607-5008
US

IV. Provider business mailing address

336 DEERFIELD RD
BOONE NC
28607-5008
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-4100
  • Fax: 828-262-4103
Mailing address:
  • Phone: 828-262-9168
  • Fax: 828-262-4103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number003124
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.09224-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: