Individual
DUSTIN B IVEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2124 14TH ST, MERIDIAN, MS 39301-4040
(601) 553-6000
(601) 553-6115
Mailing address
86 STREBECK RD, HICKORY, MS 39332-3252
(601) 635-4475
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R857409
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009969945
—
AL
05
—
06178571
—
MS
01
—
730-15574
BLUE CROSS OF AL
AL
Enumeration date
08/11/2006
Last updated
07/08/2007
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