Individual
JEFFREY A ANDRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
15200 COMMUNITY RD, GULFPORT, MS 39503-3085
(228) 575-7000
Mailing address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
(228) 497-7576
(228) 497-8869
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
093642
LA
367500000X
Certified Registered Nurse Anesthetist
779617
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
901434
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011886
—
LA
05
—
211608906
—
TX
05
—
211608907
—
TX
01
—
8839UA
BLUE CROSS BLUE SHIELD
TX
Enumeration date
05/24/2007
Last updated
01/30/2023
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