Provider Demographics
NPI:1497053268
Name:DOWNEY, JENNIFER L (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:DOWNEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:LASITER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:431 RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-9075
Mailing Address - Country:US
Mailing Address - Phone:318-294-4799
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-525-1914
Practice Address - Fax:903-525-1930
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX796248367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8266UBOtherBCBS
TXP00933621OtherMEDICARE RR
TX280427001Medicaid
TXTIN PLUS 015OtherTRICARE
TXP00933621OtherMEDICARE RR