Provider Demographics
NPI:1033133657
Name:LUCE, JESSICA LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:LUCE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:RUSHING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3728 SEAMIST DR
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5426
Mailing Address - Country:US
Mailing Address - Phone:228-990-9977
Mailing Address - Fax:
Practice Address - Street 1:3728 SEAMIST DR
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-5426
Practice Address - Country:US
Practice Address - Phone:228-990-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-095313367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51535829OtherBLUE SHIELD
AL009938166Medicaid
MS04878079Medicaid
MS04878079Medicaid