Provider Demographics
NPI:1073638722
Name:RICE, JOANNE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JOANNE
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:2204 PAVILION DR STE 105
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4651
Mailing Address - Country:US
Mailing Address - Phone:423-392-6100
Mailing Address - Fax:423-392-6159
Practice Address - Street 1:2204 PAVILION DR
Practice Address - Street 2:SUITE 105
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4657
Practice Address - Country:US
Practice Address - Phone:423-392-6100
Practice Address - Fax:423-392-6159
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50716367500000X
TN9077367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508912Medicaid
TN4044529OtherBLUE CROSS INDIVIDUAL #