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NPI Code Detail

MEDICARE: JESSICA LEE GLASS CRNA

MEDICARE: JESSICA LEE GLASS CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist3993AKY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24205845OTHERTNBLUE CROSS BLUE SHIELD OF TENNESSEE

General Provider Information

NPI Number : 1013903921
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LEE GLASS CRNA
Provider Business Mailing Address
First Line : 709 CHEATHAM ST
Second Line :
City : SPRINGFIELD
State : TN
Zip : 37172-2828
Country : US
Telephone Number : 615-212-0082
Fax Number :
Provider Business Practice Location Address
First Line : 709 CHEATHAM ST
Second Line :
City : SPRINGFIELD
State : TN
Zip : 37172-2828
Country : US
Telephone Number : 615-212-0082
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 09/29/2021

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