Healthcare Provider Details

I. General information

NPI: 1538592027
Provider Name (Legal Business Name): CAJUN ANESTHESIA APRN-CRNA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 E CHERRY ST
CUSHING OK
74023-4101
US

IV. Provider business mailing address

PO BOX 1998
WICHITA KS
67201-1998
US

V. Phone/Fax

Practice location:
  • Phone: 800-475-6236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BARRAS
Title or Position: CRNA
Credential:
Phone: 800-475-6236