Provider Demographics
NPI:1285636803
Name:WORLEY, RICHARD C (CRNA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:WORLEY
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 1:1 OLD MILL CIR
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-5804
Mailing Address - Country:US
Mailing Address - Phone:417-437-2712
Mailing Address - Fax:417-627-0130
Practice Address - Street 1:1 OLD MILL CIR
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-5804
Practice Address - Country:US
Practice Address - Phone:417-437-2712
Practice Address - Fax:417-627-0130
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111469367500000X
ARCO1214367500000X
KS55052367500000X
OKR0073155367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO912886629Medicaid
MO912886629Medicaid
MOP00073091Medicare PIN