Provider Demographics
NPI:1467580886
Name:ADAMS, JODY D (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JODY
Middle Name:D
Last Name:ADAMS
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:PO BOX 1547
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65302-1547
Mailing Address - Country:US
Mailing Address - Phone:660-826-5960
Mailing Address - Fax:660-826-4852
Practice Address - Street 1:1118 S FARMERVILLE ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5914
Practice Address - Country:US
Practice Address - Phone:318-232-7119
Practice Address - Fax:318-232-1092
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP03708367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1433098Medicaid
LA390440ZMC5Medicare PIN