Individual
MRS. IDA PERNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1900 EXETER RD, SUITE 210, GERMANTOWN, TN 38138-2954
(901) 818-2160
(901) 682-9522
Mailing address
1900 EXETER RD, SUITE 210, GERMANTOWN, TN 38138-2954
(901) 818-2160
(901) 682-9522
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
044684
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
8954
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126210
—
MS
05
—
3625361
—
TN
01
—
4011478
BLUE CROSS
TN
01
—
430074179
RAILROAD MEDICARE
TN
01
—
98971
BLUE CROSS
AR
Enumeration date
05/15/2006
Last updated
06/09/2011
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