Provider Demographics
NPI:1952742496
Name:NUNNERY, JODY PATRICK (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JODY
Middle Name:PATRICK
Last Name:NUNNERY
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 1:56365 STRAUGHAN NURSERY RD
Mailing Address - Street 2:
Mailing Address - City:LORANGER
Mailing Address - State:LA
Mailing Address - Zip Code:70446-2817
Mailing Address - Country:US
Mailing Address - Phone:985-878-0385
Mailing Address - Fax:
Practice Address - Street 1:56365 STRAUGHAN NURSERY RD
Practice Address - Street 2:
Practice Address - City:LORANGER
Practice Address - State:LA
Practice Address - Zip Code:70446-2817
Practice Address - Country:US
Practice Address - Phone:985-878-0385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07451367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1952742496OtherBCBS OF LA