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General NPI Number Information
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NPI Number | 1376596106
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Entity Type | Individual
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Provider Name | JEFFREY L CUNNINGHAM CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 275 HIGHWAY 770
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City | CORBIN
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State | KY
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Zip | 40701-4732
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Country | US
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Telephone | 606-526-7874
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33087
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City | KNOXVILLE
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State | TN
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Zip | 37930-3087
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Country | US
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Telephone | 865-691-2993
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Fax | 865-691-2997
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN1100047/ARNP3927A
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License Number State | KY
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