Provider Demographics
NPI:1942504048
Name:CRNA TEXAS, INC.
Entity Type:Organization
Organization Name:CRNA TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:
Authorized Official - First Name:SHONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:325-262-2581
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:MERTZON
Mailing Address - State:TX
Mailing Address - Zip Code:76941-0378
Mailing Address - Country:US
Mailing Address - Phone:325-262-2581
Mailing Address - Fax:
Practice Address - Street 1:5601 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-1225
Practice Address - Country:US
Practice Address - Phone:325-690-4466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX052478367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty