Individual
JASON TIBBETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
200 TYLER ST, WEST MEMPHIS, AR 72301
(870) 735-1500
(870) 733-3861
Mailing address
PO BOX 5887, ALEXANDRIA, LA 71307-5887
(870) 735-1500
(870) 733-3861
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
169954
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
AP07594
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
169954
TN LICENSE
—
Enumeration date
03/25/2011
Last updated
12/17/2018
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