Provider Demographics
NPI:1588803225
Name:PEREZ, ALLYSON (CRNA)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:CRAWFORD
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3509 FORREST PRESERVE
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5834
Mailing Address - Country:US
Mailing Address - Phone:228-217-2056
Mailing Address - Fax:
Practice Address - Street 1:2101 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-5340
Practice Address - Country:US
Practice Address - Phone:228-497-7576
Practice Address - Fax:228-497-7576
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR861252367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS512I430302Medicare PIN