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General NPI Number Information
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NPI Number | 1851330666
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Entity Type | Individual
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Provider Name | CECIL TIMOTHY JACKSON CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 90 HIGHWAY 91 SOUTH C/O BARRETT HOSPITAL & HEALTHCARE
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City | DILLON
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State | MT
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Zip | 59725-3597
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Country | US
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Telephone | 406-683-3000
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Fax | 406-683-3011
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Provider Business Mailing Address
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Address Line | 203 S DAISY ST
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City | SALMON
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State | ID
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Zip | 83467-4709
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Country | US
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Telephone | 208-756-2429
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Fax | 208-756-2429
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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 | 29774
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License Number State | MT
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