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General NPI Number Information
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NPI Number | 1376603290
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Entity Type | Individual
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Provider Name | JESSE LYNN RYAN CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 521 HILL STREET, SW
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City | THOMSON
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State | GA
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Zip | 30824-2118
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Country | US
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Telephone | 706-597-5239
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Fax | 706-597-5141
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Provider Business Mailing Address
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Address Line | 4282 DEERWOOD LN
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City | EVANS
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State | GA
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Zip | 30809-4224
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Country | US
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Telephone | 706-597-5239
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Fax | 706-597-5141
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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 | APRN-CRNA074053
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License Number State | GA
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