Provider Demographics
NPI:1659324341
Name:BLOODWORTH, DAUREEN K (CRNA)
Entity Type:Individual
Prefix:
First Name:DAUREEN
Middle Name:K
Last Name:BLOODWORTH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DAUREEN
Other - Middle Name:L
Other - Last Name:KELLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-1198
Mailing Address - Country:US
Mailing Address - Phone:325-670-4220
Mailing Address - Fax:325-670-4040
Practice Address - Street 1:1755 KIRBY PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4398
Practice Address - Country:US
Practice Address - Phone:901-725-5846
Practice Address - Fax:901-726-4827
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11951367500000X
TXAP127584367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00440722OtherRR MEDICARE
TN3935986Medicaid
MS00527025Medicaid
TN4134142OtherBCBS
TN4134142OtherBCBS