Provider Demographics
NPI:1093092884
Name:KAISER, JESSE GLENN (CRNA)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:GLENN
Last Name:KAISER
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:7 INDEPENDENCE PT STE 300
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4569
Practice Address - Country:US
Practice Address - Phone:864-522-3700
Practice Address - Fax:864-522-3705
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17741367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNPI # / SSN#OtherTRICARE
GA003120496AMedicaid
SCNPI # / SSN#OtherBLUE CHOICE
SC476534OtherUNISON
SCNPI # / SSN#OtherBLUE CROSS
SC30108533OtherFIRST CHOICE - SELECT HEALTH
SCNPI # / SSN#OtherTRICARE
SC30108533OtherFIRST CHOICE - SELECT HEALTH