Healthcare Provider Details

I. General information

NPI: 1588101299
Provider Name (Legal Business Name): JESSICA DEE GREGSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 MILL STONE RD
CHESAPEAKE VA
23322-4339
US

IV. Provider business mailing address

1412 FLYFISHER CT
VIRGINIA BEACH VA
23456-1500
US

V. Phone/Fax

Practice location:
  • Phone: 404-895-2836
  • Fax:
Mailing address:
  • Phone: 803-448-5840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024174384
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: