Provider Demographics
NPI:1467498535
Name:HERSCHELMAN, PATRICK LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:LEE
Last Name:HERSCHELMAN
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 24776
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37422
Mailing Address - Country:US
Mailing Address - Phone:877-288-1799
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:907 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5015
Practice Address - Country:US
Practice Address - Phone:865-983-7211
Practice Address - Fax:865-983-8043
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO140556367500000X
VA0001229638367500000X
TN10459367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100021714OtherPHP TENNCARE
MO127254OtherBLUE CROSS
TN3626241Medicaid
TN4096641OtherBLUE CROSS
TNP00201599OtherMEDICARE TRAVELERS
MO477005OtherHEALTHLINK
TN4096641OtherBLUECARE
MO915929715Medicaid
MO127254OtherBLUE CROSS
MO477005OtherHEALTHLINK
MOP00609897Medicare PIN
MO833530635Medicare PIN
TN4096641OtherBLUE CROSS