Provider Demographics
NPI:1639940125
Name:SEPULVADO, JARRED DEWAYNE (DNP, CRNA)
Entity Type:Individual
Prefix:DR
First Name:JARRED
Middle Name:DEWAYNE
Last Name:SEPULVADO
Suffix:
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 TUNICA TRL
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5192
Mailing Address - Country:US
Mailing Address - Phone:318-780-0329
Mailing Address - Fax:
Practice Address - Street 1:605 TUNICA TRL
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5192
Practice Address - Country:US
Practice Address - Phone:318-780-0329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200185367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered