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MR. JOHN THAYER EDMONDSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
2323 TEXAS ST, PECOS, TX 79772-7338
(432) 447-3551
(432) 447-5434
Mailing address
2323 TEXAS ST, PECOS, TX 79772-7338
(432) 447-3551
(432) 447-5434

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP115284
TX
367500000X
Certified Registered Nurse Anesthetist
RN043542
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
023413
CRNA CERTIFICATION NUMBER
TN
05
202890402
TX
Enumeration date
04/14/2006
Last updated
08/31/2015
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