Healthcare Provider Details

I. General information

NPI: 1205108719
Provider Name (Legal Business Name): WILLIAM JOHN ROLFES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 W 15TH ST
PLANO TX
75075-7738
US

IV. Provider business mailing address

12222 MERIT DR STE 600
DALLAS TX
75251-3294
US

V. Phone/Fax

Practice location:
  • Phone: 214-970-6817
  • Fax:
Mailing address:
  • Phone: 888-339-8727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024169815
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number43-558274-062
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2024047434
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number912991
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: