Provider Demographics
NPI:1073725677
Name:STUART, JEFFERY JOSEPH (CRNA)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:JOSEPH
Last Name:STUART
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22 DOCTORS DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39566-0789
Mailing Address - Country:US
Mailing Address - Phone:228-818-0563
Mailing Address - Fax:228-818-0519
Practice Address - Street 1:22 DOCTORS DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39566-0789
Practice Address - Country:US
Practice Address - Phone:228-818-0563
Practice Address - Fax:228-818-0519
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR853260207LP3000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology