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General NPI Number Information
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NPI Number | 1669562658
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Entity Type | Individual
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Provider Name | CHRISTOPHER ALAN HENTHORNE CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 100 MERCY WAY
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City | JOPLIN
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State | MO
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Zip | 64804-4524
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Country | US
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Telephone | 417-781-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 810 BYRNE ST
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City | NEW ALBANY
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State | MS
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Zip | 38652-5401
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Country | US
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Telephone | 662-668-0660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R52164
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 2025008082
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License Number State | MO
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