Individual
MR. JAMES EARL BANKHEAD JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6441
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6441
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
901360
MS
367500000X
Certified Registered Nurse Anesthetist
AP129256
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08028053
—
MS
01
—
P01763996
RAILROAD MEDICARE
MS
Enumeration date
10/16/2015
Last updated
02/06/2017
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