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NPI Code Detail

MEDICARE: MR. THOMAS EDWARD JAYNES CRNA

MEDICARE: MR. THOMAS EDWARD JAYNES CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist211298LA

General Provider Information

NPI Number : 1114755469
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THOMAS EDWARD JAYNES CRNA
Provider Business Mailing Address
First Line : 1541 KINGS HWY
Second Line : ATTN: PAYOR CREDENTIALING
City : SHREVEPORT
State : LA
Zip : 71103-4228
Country : US
Telephone Number : 318-626-0287
Fax Number :
Provider Business Practice Location Address
First Line : 1541 KINGS HWY
Second Line :
City : SHREVEPORT
State : LA
Zip : 71103-4228
Country : US
Telephone Number : 318-626-0000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2024
Last Update Date : 03/12/2026

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