Healthcare Provider Details

I. General information

NPI: 1922378421
Provider Name (Legal Business Name): JARED ROSS WINGERT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2011
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 W DESCHUTES PL STE B
KENNEWICK WA
99336-7719
US

IV. Provider business mailing address

4506 W 20TH AVE
KENNEWICK WA
99338-1824
US

V. Phone/Fax

Practice location:
  • Phone: 509-375-5000
  • Fax:
Mailing address:
  • Phone: 803-447-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2012019347
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR204149
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: