Healthcare Provider Details

I. General information

NPI: 1588803225
Provider Name (Legal Business Name): ALLYSON PEREZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLYSON CRAWFORD ROBERTSON CRNA

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 HIGHWAY 90
GAUTIER MS
39553-5340
US

IV. Provider business mailing address

3509 FORREST PRESERVE
GAUTIER MS
39553-5834
US

V. Phone/Fax

Practice location:
  • Phone: 228-497-7576
  • Fax: 228-497-7576
Mailing address:
  • Phone: 228-217-2056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR861252
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: