Provider Demographics
NPI:1336228576
Name:HERNANDEZ, JOHN A
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-0549
Mailing Address - Country:US
Mailing Address - Phone:903-693-3841
Mailing Address - Fax:903-694-4633
Practice Address - Street 1:409 COTTAGE RD
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-1466
Practice Address - Country:US
Practice Address - Phone:903-693-3841
Practice Address - Fax:903-694-4633
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222941367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C42POtherBLUE CROSS CRNA