Provider Demographics
NPI:1720084908
Name:LLOYD, JAMES EDWARD JR (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:LLOYD
Suffix:JR
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 1:1500 STATE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067
Mailing Address - Country:US
Mailing Address - Phone:660-259-2203
Mailing Address - Fax:660-259-6819
Practice Address - Street 1:1500 STATE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1107
Practice Address - Country:US
Practice Address - Phone:660-259-2203
Practice Address - Fax:660-259-6819
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO27767367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO912807757Medicaid
MO912807757Medicaid