Healthcare Provider Details

I. General information

NPI: 1780636738
Provider Name (Legal Business Name): JOHN NELSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 EXETER RD SUITE 210
GERMANTOWN TN
38138-2954
US

IV. Provider business mailing address

1900 EXETER RD STE 210
GERMANTOWN TN
38138-2954
US

V. Phone/Fax

Practice location:
  • Phone: 901-818-2160
  • Fax: 901-682-9522
Mailing address:
  • Phone: 901-818-2160
  • Fax: 901-682-9522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9299
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: