Individual
JACOB KYLE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 958-8000
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
(540) 224-5715
(540) 224-5684
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024175752
VA
367500000X
Certified Registered Nurse Anesthetist
118744
VA
Other
Enumeration date
01/02/2018
Last updated
08/09/2022
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