Provider Demographics
NPI:1255410593
Name:COY, JERRY EVAN (CRNA)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:EVAN
Last Name:COY
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 1:130 DEVONSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-8111
Mailing Address - Country:US
Mailing Address - Phone:910-392-6902
Mailing Address - Fax:
Practice Address - Street 1:111 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-2011
Practice Address - Country:US
Practice Address - Phone:252-641-7170
Practice Address - Fax:252-641-7373
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106170163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse