Healthcare Provider Details

I. General information

NPI: 1598855504
Provider Name (Legal Business Name): BENNIE B BATSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 BRIARCREST DR SUITE 14
BRYAN TX
77802-2769
US

IV. Provider business mailing address

1737 BRIARCREST DR SUITE 14
BRYAN TX
77802-2769
US

V. Phone/Fax

Practice location:
  • Phone: 979-776-4777
  • Fax: 979-776-0588
Mailing address:
  • Phone: 979-776-4777
  • Fax: 979-776-0588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP119961
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: