Individual
JEREMY RYAN COY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
210668
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
89988
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760758973
TRICARE
NC
05
—
8054207
—
NC
01
—
P01111573
RAILROAD MEDICARE
NC
Enumeration date
04/02/2012
Last updated
02/05/2013
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