Provider Demographics
NPI:1194180786
Name:MASON, JERICA S (DNP, CRNA)
Entity Type:Individual
Prefix:
First Name:JERICA
Middle Name:S
Last Name:MASON
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 WOLF PARK DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1741
Mailing Address - Country:US
Mailing Address - Phone:731-695-3467
Mailing Address - Fax:
Practice Address - Street 1:1900 EXETER RD STE 210
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2954
Practice Address - Country:US
Practice Address - Phone:901-818-2160
Practice Address - Fax:901-682-9443
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN184660163W00000X
TN20943367500000X
TN109839367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse