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General NPI Number Information
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NPI Number | 1255410593
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Entity Type | Individual
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Provider Name | JERRY EVAN COY CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 111 HOSPITAL DR
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City | TARBORO
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State | NC
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Zip | 27886-2011
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Country | US
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Telephone | 252-641-7170
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Fax | 252-641-7373
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Provider Business Mailing Address
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Address Line | 130 DEVONSHIRE LN
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City | WILMINGTON
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State | NC
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Zip | 28409-8111
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Country | US
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Telephone | 910-392-6902
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 106170
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License Number State | NC
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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 | 106170
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License Number State | NC
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