Provider Demographics
NPI:1336122472
Name:KIRKSEY PEREZ, JEANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:KIRKSEY PEREZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:D
Other - Last Name:KIRKSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3705 MEDICAL PKWY
Mailing Address - Street 2:SUITE 570
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1019
Mailing Address - Country:US
Mailing Address - Phone:512-454-2454
Mailing Address - Fax:512-454-1532
Practice Address - Street 1:3705 MEDICAL PKWY
Practice Address - Street 2:SUITE 570
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1019
Practice Address - Country:US
Practice Address - Phone:512-454-2454
Practice Address - Fax:512-454-1532
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43699367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89036001Medicaid
TX87617COtherBC/BS
TX89036001Medicaid
TX87617CMedicare PIN