Healthcare Provider Details

I. General information

NPI: 1407366529
Provider Name (Legal Business Name): ANTHONY CHASE WARREN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S BECKHAM AVE
TYLER TX
75701-1908
US

IV. Provider business mailing address

PO BOX 8027
TYLER TX
75711-8027
US

V. Phone/Fax

Practice location:
  • Phone: 903-597-0351
  • Fax:
Mailing address:
  • Phone: 800-411-7513
  • Fax: 817-334-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP136704
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: