Individual
JOSHUA E FUQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5900
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5900
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R874367
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04304705
—
MS
01
—
272030YPC0
MEDICARE PTAN
MS
01
—
P01678538
RAILROAD MEDICARE PTAN
MS
Enumeration date
12/27/2012
Last updated
08/17/2016
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