Provider Demographics
NPI:1790770451
Name:DRIVER, JOHN R (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:DRIVER
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 1:806 LAKEHOME LN
Mailing Address - Street 2:
Mailing Address - City:CAPE FAIR
Mailing Address - State:MO
Mailing Address - Zip Code:65624-5305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:806 LAKEHOME LN
Practice Address - Street 2:
Practice Address - City:CAPE FAIR
Practice Address - State:MO
Practice Address - Zip Code:65624-5305
Practice Address - Country:US
Practice Address - Phone:417-669-9382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO058819367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO194111OtherBCBS
MO912834686Medicaid
MO22941OtherCOX HEALTH
AR158514001Medicaid
MO210165OtherHEALTHLINK
MO912834611Medicaid
MOP00217677OtherRAILROAD
OK200089370AMedicaid
MO20174319965616B008OtherTRICARE