Provider Demographics
NPI:1376596106
Name:CUNNINGHAM, JEFFREY L (CRNA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:CUNNINGHAM
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:PO BOX 33087
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-3087
Mailing Address - Country:US
Mailing Address - Phone:865-691-2993
Mailing Address - Fax:865-691-2997
Practice Address - Street 1:275 HIGHWAY 770
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4732
Practice Address - Country:US
Practice Address - Phone:606-526-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRN1100047/ARNP3927A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1225725OtherCHA HEALTH
KYC20336OtherCUMBERLAND HEALTHCARE
KY000000383672OtherANTHEM BCBS KY
KY74011677Medicaid
KY74011677Medicaid
KY0907310Medicare ID - Type UnspecifiedADMINISTAR FEDERAL