MEDICARE: JP ANESTHESIA A PROFESSIONAL CORPORATION

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

General Provider Information

NPI Number	:	1811687148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JP ANESTHESIA A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 55990
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72215-5990
Country	:	US
Telephone Number	:	501-227-0700
Fax Number	:	501-227-0744

Provider Business Practice Location Address
First Line	:	1250 PECANLAND RD
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71203-7011
Country	:	US
Telephone Number	:	318-387-2015
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JILL PARKMAN
Credential	:	CRNA
Telephone Number	:	318-514-8701

Provider Enumeration Date	:	05/10/2023
Last Update Date	:	07/26/2023

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