Individual
JOHN GLYNN JEANSONNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1000 S BECKHAM AVE, TYLER, TX 75701-1908
(903) 526-1068
(903) 593-4290
Mailing address
PO BOX 8027, TYLER, TX 75711-8027
(903) 526-1068
(903) 593-4290
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
451178
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86317U
BCBS OF TEXAS
TX
01
—
P00301320
RAILROAD MEDICARE PART B
TX
Enumeration date
10/27/2006
Last updated
07/08/2007
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