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General NPI Number Information
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NPI Number | 1073725677
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Entity Type | Individual
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Provider Name | JEFFERY JOSEPH STUART CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 22 DOCTORS DRIVE SUITE C
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City | OCEAN SPRINGS
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State | MS
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Zip | 39566-0789
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Country | US
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Telephone | 228-818-0563
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Fax | 228-818-0519
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Provider Business Mailing Address
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Address Line | 22 DOCTORS DRIVE SUITE C
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City | OCEAN SPRINGS
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State | MS
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Zip | 39566-0789
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Country | US
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Telephone | 228-818-0563
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Fax | 228-818-0519
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | R853260
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R853260
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License Number State | MS
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