Individual
MR. DOUGLAS ALLAN LOVERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
766 LAKELAND DR STE A, JACKSON, MS 39216-4610
(601) 368-3440
Mailing address
PO BOX 5371, BRANDON, MS 39047-5371
(601) 992-1801
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902973
MS
367500000X
Certified Registered Nurse Anesthetist
R801579
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03037303
—
MS
01
—
P00745655
MEDICARE RAILROAD
MS
Enumeration date
07/18/2006
Last updated
12/11/2018
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