Healthcare Provider Details

I. General information

NPI: 1669432324
Provider Name (Legal Business Name): RONALD W COYLE JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8166 MAIN ST
HOUMA LA
70360
US

IV. Provider business mailing address

PO BOX 6014
HOUMA LA
70361-6014
US

V. Phone/Fax

Practice location:
  • Phone: 985-873-4141
  • Fax: 985-851-4307
Mailing address:
  • Phone: 985-850-6398
  • Fax: 985-873-3789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number08563504333
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA223018
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP04333
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: