MEDICARE: JARED Y ROBERTSON III 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
1	367500000X	Certified Registered Nurse Anesthetist	10597	TN
2	367500000X	Certified Registered Nurse Anesthetist	5201	LA
3	367500000X	Certified Registered Nurse Anesthetist	4858A	KY
4	367500000X	Certified Registered Nurse Anesthetist	24167318	VA
5	367500000X	Certified Registered Nurse Anesthetist	3625	SC
6	367500000X	Certified Registered Nurse Anesthetist	71550	NC
7	367500000X	Certified Registered Nurse Anesthetist	144482	TX
8	367500000X	Certified Registered Nurse Anesthetist	901491	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4081487	OTHER	BLUE SHIELD OF TN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	TN0100	OTHER	JOHN DEERE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	00013859	OTHER	NHC CARE ADMINISTRATORS
8	146158	OTHER	ANTHEM BCBS

General Provider Information

NPI Number	:	1265428734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED Y ROBERTSON III CRNA

Provider Business Mailing Address
First Line	:	1514 JEFFERSON HWY
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70121-2429
Country	:	US
Telephone Number	:	504-842-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 DRINKWATER RD
Second Line	:
City	:	BAY ST LOUIS
State	:	MS
Zip	:	39520-1658
Country	:	US
Telephone Number	:	228-467-8600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	11/10/2022

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