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General NPI Number Information
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NPI Number | 1932528296
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Entity Type | Individual
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Provider Name | WILSON DESHON CHRISTIAN IV CRNA
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 1125 MADISON ST
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City | JEFFERSON CITY
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State | MO
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Zip | 65101-5227
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Country | US
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Telephone | 573-632-5000
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Fax | 573-632-5876
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Provider Business Mailing Address
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Address Line | PO BOX 844658
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City | DALLAS
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State | TX
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Zip | 75284-4658
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Country | US
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Telephone | 800-994-0371
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Fax | 254-215-9722
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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 | 3008612
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License Number State | KY
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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 | 006320
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP137488
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 0024179286
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 2018040400
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License Number State | MO
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Taxonomy #6
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 7809
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License Number State | MA
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Taxonomy #7
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 0000024792
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License Number State | TN
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