Healthcare Provider Details

I. General information

NPI: 1588760409
Provider Name (Legal Business Name): JAY PALMER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CARLISLE ST
NATRONA HEIGHTS PA
15065-1152
US

IV. Provider business mailing address

272 HOSPITAL RD SUITE 3
CHILLICOTHEE OH
45601-9031
US

V. Phone/Fax

Practice location:
  • Phone: 724-226-7010
  • Fax: 724-226-7404
Mailing address:
  • Phone: 740-779-8234
  • Fax: 740-779-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number327416
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN656645
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: