Provider Demographics
NPI:1568417517
Name:CARLISLE, CURT B (CRNA)
Entity Type:Individual
Prefix:
First Name:CURT
Middle Name:B
Last Name:CARLISLE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-624-5202
Mailing Address - Fax:417-206-0916
Practice Address - Street 1:15 WOODCREST DR
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-5828
Practice Address - Country:US
Practice Address - Phone:417-624-5202
Practice Address - Fax:417-206-0916
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO090557367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO912769239Medicaid
MO095060096Medicare PIN