Individual
MR. JERRY W GOSTNELL II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
BAYNE-JONES ARMY COMMUNICTY HOSPITAL, 1585 THIRD ST, FORT POLK, LA 71459
(337) 531-3343
Mailing address
369 J BAR RUN, LEESVILLE, LA 71446-6465
(337) 509-5409
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
187722
GA
163W00000X
Registered Nurse
74288
HI
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN.CRNA.0020337
OH
Other
Enumeration date
03/12/2014
Last updated
02/03/2023
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