Healthcare Provider Details

I. General information

NPI: 1770136855
Provider Name (Legal Business Name): ALAINA LITTLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 INNOVATION DR
JACKSON TN
38305-3019
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 315
MEMPHIS TN
38120-9401
US

V. Phone/Fax

Practice location:
  • Phone: 731-986-7259
  • Fax: 731-868-8289
Mailing address:
  • Phone: 877-348-1281
  • Fax: 901-227-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26426
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: