=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720825482
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES EDWARD MILES CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2024
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1619 K66
-----------------------------------------------------
City | GALENA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66739-4306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-358-8121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1506 GOLD DUST DR
-----------------------------------------------------
City | WEBB CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64870-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-592-9304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 2025016993
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 223143
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 162978
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------