Provider Demographics
NPI:1285616532
Name:WEBB, TIERANY L (CRNA)
Entity type:Individual
Prefix:MS
First Name:TIERANY
Middle Name:L
Last Name:WEBB
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:TIERANY
Other - Middle Name:L
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5873 BAYOU DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4987
Mailing Address - Country:US
Mailing Address - Phone:318-752-1019
Mailing Address - Fax:
Practice Address - Street 1:2600 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3908
Practice Address - Country:US
Practice Address - Phone:318-212-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN086356 AP03977367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1118150Medicaid
LAP00115429Medicare PIN
LA1118150Medicaid