Individual
KEVIN WAYNE CALLAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
211 SAINT FRANCIS DR, CAPE GIRARDEAU, MO 63703-5049
(573) 331-3000
(913) 341-5797
Mailing address
211 SAINT FRANCIS DR, CAPE GIRARDEAU, MO 63703-5049
(573) 339-5716
(913) 341-5797
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
135873
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
498862850001
—
IL
05
—
9172222000
—
MO
01
—
A174
CHAMPUS/TRICARE
MO
01
—
P00353176
RAILROAD
MO
Enumeration date
07/18/2006
Last updated
06/25/2009
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