Provider Demographics
NPI:1033318381
Name:SEYMOUR, JAY HOWARD (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:HOWARD
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53533
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-3533
Mailing Address - Country:US
Mailing Address - Phone:337-406-1044
Mailing Address - Fax:
Practice Address - Street 1:600 N LEWIS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2043
Practice Address - Country:US
Practice Address - Phone:337-365-3168
Practice Address - Fax:337-369-3536
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05215367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered