Provider Demographics
NPI:1750332391
Name:BOYER, JEREMY JOSEPH (CRNA)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:JOSEPH
Last Name:BOYER
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 1:305 AMBERGRIS LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8152
Mailing Address - Country:US
Mailing Address - Phone:337-280-9311
Mailing Address - Fax:
Practice Address - Street 1:305 AMBERGRIS LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8152
Practice Address - Country:US
Practice Address - Phone:337-280-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN105054367500000X
LAAP04848367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered