Provider Demographics
NPI:1629536271
Name:HAYTER, CAMERON DAVID (CRNA)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:DAVID
Last Name:HAYTER
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 1:1951 N CITATION AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-5406
Mailing Address - Country:US
Mailing Address - Phone:417-337-4343
Mailing Address - Fax:
Practice Address - Street 1:1951 N CITATION AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-5406
Practice Address - Country:US
Practice Address - Phone:417-337-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-03
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014002877367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered