Provider Demographics
NPI:1740257849
Name:TENNISON, ALLEN T (CRNA)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:T
Last Name:TENNISON
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 1:714 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1833
Mailing Address - Country:US
Mailing Address - Phone:903-595-4333
Mailing Address - Fax:903-535-9845
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-531-4522
Practice Address - Fax:903-531-4522
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX451001367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80115HOtherBCBS
TX80115HOtherBCBS