Provider Demographics
NPI:1598717076
Name:AVERY, JEFFREY MICHAEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:AVERY
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 1:810 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-2109
Mailing Address - Country:US
Mailing Address - Phone:662-315-6092
Mailing Address - Fax:662-651-4636
Practice Address - Street 1:830 S GLOSTER ST
Practice Address - Street 2:NORTH MS MEDICAL CENTER
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4934
Practice Address - Country:US
Practice Address - Phone:662-841-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR855712367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered