Healthcare Provider Details

I. General information

NPI: 1285664367
Provider Name (Legal Business Name): LARRY JEWELL CRNA RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N HIGHLAND AVE
SHERMAN TX
75092-7354
US

IV. Provider business mailing address

119 W HOUSTON ST
SHERMAN TX
75090-5909
US

V. Phone/Fax

Practice location:
  • Phone: 903-891-7000
  • Fax: 903-893-5334
Mailing address:
  • Phone: 903-891-7000
  • Fax: 903-893-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number566292
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number24291
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: