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General NPI Number Information
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NPI Number | 1922378421
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Entity Type | Individual
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Provider Name | JARED ROSS WINGERT CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/31/2011
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 7501 W DESCHUTES PL STE B
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City | KENNEWICK
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State | WA
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Zip | 99336-7719
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Country | US
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Telephone | 509-375-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 4506 W 20TH AVE
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City | KENNEWICK
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State | WA
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Zip | 99338-1824
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Country | US
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Telephone | 803-447-0060
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 2012019347
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R204149
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License Number State | SC
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