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NPI Code Detail

MEDICARE: MR. DAVID BLAIR COSTON MSN-CRNA

MEDICARE: MR. DAVID BLAIR COSTON MSN-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 AnesthetistRN144326/APN11254TN
2367500000XCertified Registered Nurse Anesthetist144326TN
3367500000XCertified Registered Nurse Anesthetist11254TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00323543OTHERTNRAILROAD MEDICARE PIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14119264OTHERTNBLUE CROSS/BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
44119264OTHERTNBCBS TN

General Provider Information

NPI Number : 1780637587
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID BLAIR COSTON MSN-CRNA
Provider Business Mailing Address
First Line : 12752 KINGSTON PIKE
Second Line : STE E202
City : KNOXVILLE
State : TN
Zip : 37934-0948
Country : US
Telephone Number : 865-777-0909
Fax Number : 865-777-0910
Provider Business Practice Location Address
First Line : 432 2ND STREET
Second Line :
City : NEWPORT
State : TN
Zip : 37821-3703
Country : US
Telephone Number : 865-777-0909
Fax Number : 865-777-0910
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2006
Last Update Date : 01/11/2011

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