Provider Demographics
NPI:1104806652
Name:JARVIS, JAYSON S (CRNA)
Entity type:Individual
Prefix:
First Name:JAYSON
Middle Name:S
Last Name:JARVIS
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 1:415 N CENTER ST
Mailing Address - Street 2:STE 201
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5036
Mailing Address - Country:US
Mailing Address - Phone:828-327-8105
Mailing Address - Fax:828-327-4245
Practice Address - Street 1:415 N CENTER ST
Practice Address - Street 2:STE 201
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5036
Practice Address - Country:US
Practice Address - Phone:828-327-8105
Practice Address - Fax:828-327-4245
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC176521367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051484Medicaid
NC2601720Medicare ID - Type Unspecified
NC8051484Medicaid