Provider Demographics
NPI:1992908321
Name:LOUPE, JERICHO GERALD JOSEPH (CRNA)
Entity type:Individual
Prefix:
First Name:JERICHO
Middle Name:GERALD JOSEPH
Last Name:LOUPE
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 1:13501 SETTLERS TRL
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4391
Mailing Address - Country:US
Mailing Address - Phone:956-330-1089
Mailing Address - Fax:
Practice Address - Street 1:1305 WONDER WORLD DR STE 105
Practice Address - Street 2:YPS-CREDENTIALING
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7502
Practice Address - Country:US
Practice Address - Phone:512-353-8161
Practice Address - Fax:512-353-8255
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX686187367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158772704Medicaid
TXP01163791OtherRR MEDICARE
TX8869UDOtherBCBS OF TX
TX8869UDOtherBCBS OF TX