Provider Demographics
NPI:1972096733
Name:RAUCHLE, KRISTOPHER WAYNE (CRNA)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:WAYNE
Last Name:RAUCHLE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNAP, CRNA
Mailing Address - Street 1:1671 FOXBORO CT
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-9369
Mailing Address - Country:US
Mailing Address - Phone:816-520-3326
Mailing Address - Fax:
Practice Address - Street 1:1531 E 32ND ST STE 6
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2970
Practice Address - Country:US
Practice Address - Phone:417-553-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011011036163W00000X
MO117738367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse