Provider Demographics
NPI:1720094998
Name:STOKEY, JON BRADFORD (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:BRADFORD
Last Name:STOKEY
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 1:19198 BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-9712
Mailing Address - Country:US
Mailing Address - Phone:419-658-2979
Mailing Address - Fax:419-658-2979
Practice Address - Street 1:19198 BLOSSER RD
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-9712
Practice Address - Country:US
Practice Address - Phone:419-658-2979
Practice Address - Fax:419-658-2979
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN144128367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered