MEDICARE: MR. JESSE LYNN RYAN 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
1	367500000X	Certified Registered Nurse Anesthetist	APRN-CRNA074053	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	43ZCBFH	OTHER	GA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376603290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JESSE LYNN RYAN CRNA

Provider Business Mailing Address
First Line	:	4282 DEERWOOD LN
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-4224
Country	:	US
Telephone Number	:	706-597-5239
Fax Number	:	706-597-5141

Provider Business Practice Location Address
First Line	:	521 HILL STREET, SW
Second Line	:
City	:	THOMSON
State	:	GA
Zip	:	30824-2118
Country	:	US
Telephone Number	:	706-597-5239
Fax Number	:	706-597-5141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	03/06/2026

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