Healthcare Provider Details

I. General information

NPI: 1194880419
Provider Name (Legal Business Name): JOHN PATTERSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 BIENVILLE BLVD
OCEAN SPRINGS MS
39564-4361
US

IV. Provider business mailing address

2101 HIGHWAY 90
GAUTIER MS
39553-5340
US

V. Phone/Fax

Practice location:
  • Phone: 228-818-1183
  • Fax:
Mailing address:
  • Phone: 228-497-7576
  • Fax: 228-497-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR869670
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: