Individual
JACOB J BRISCOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3100 OAK GROVE RD, POPLAR BLUFF, MO 63901-1573
(573) 776-2000
Mailing address
1201 HAMER RD, DYERSBURG, TN 38024-6908
(309) 210-6650
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
041341872
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
2024007928
MO
367500000X
Certified Registered Nurse Anesthetist
209007627
IL
Other
Enumeration date
08/28/2009
Last updated
09/09/2024
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