Individual
MR. JACKIE CLAYTON ROWE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3241 PERCY DR, CAPE GIRARDEAU, MO 63701-4901
(573) 334-1222
(573) 334-3532
Mailing address
RR 1 BOX 627A, MARBLE HILL, MO 63764-9724
(573) 238-4535
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
109722
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
109722
NURSING LICENSE
MO
01
—
44696
AANA NUMBER
MO
Enumeration date
03/31/2006
Last updated
07/08/2007
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