John Thayer Edmondson, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Pecos, TX
NPI 1295799260 · NPPES record last updated Aug 31, 2015
Key facts
- NPI
- 1295799260
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- AP115284 (TX)
- Practice address
- 2323 Texas St
Pecos, TX 79772-7338 - Phone
- (432) 447-3551
- Fax
- (432) 447-5434
- NPI assigned
- Apr 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN043542 | TN | MD | Certified Registered Nurse Anesthetist |
| AP115284 | TX | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dyersburg Hospital Company LLC | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
| Permian Anesthesia Associates, Inc | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
| Upper Cumberland Anesthesia Associates, PC | Nurse Anesthetist, Certified Registered | Past |
Accepting new patients |
| Sumner Anesthesia Associates, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | RN043542 | TN | |
| Certified Registered Nurse Anesthetist | 367500000X | AP115284 | TX | Yes |
Addresses
Primary practice location
2323 Texas St
Pecos, TX 79772-7338
Mailing address
2323 Texas St
Pecos, TX 79772-7338
Phone (432) 447-3551
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 023413 | Other | TN | CRNA CERTIFICATION NUMBER |
| 202890402 | Medicaid | TX |
Other providers in Pecos, TX
- Abigail Lauren Darnell
- Deitleman Health and Wellness
- Lori A Diaz
- Chibuikem Samuel Dimgba
- Brittney J Dye
- Diane A Evering-Simms
- Jerry F Giardina
- Roberto Gomez Jr.
- Tamara M Goodliffe
- Guadalupe County Hospital Board
All providers in Pecos, TX · Certified Registered Nurse Anesthetist in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.