Healthcare Provider Details

I. General information

NPI: 1124070719
Provider Name (Legal Business Name): ROY CURTIS GAVIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2046 BEACH BLVD APT C113
BILOXI MS
39531-5126
US

IV. Provider business mailing address

2046 BEACH BLVD APT C113
BILOXI MS
39531-5126
US

V. Phone/Fax

Practice location:
  • Phone: 318-801-5526
  • Fax:
Mailing address:
  • Phone: 318-801-5526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP04871
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN113738
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR863777
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: