Provider Demographics
NPI:1447368204
Name:ALBRITTON, JEFFREY WAYNE (MSN-CRNA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:WAYNE
Last Name:ALBRITTON
Suffix:
Gender:M
Credentials:MSN-CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 QUENSELITE TRL
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-2473
Mailing Address - Country:US
Mailing Address - Phone:865-274-9777
Mailing Address - Fax:
Practice Address - Street 1:3800 S W S YOUNG DR STE 201
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542
Practice Address - Country:US
Practice Address - Phone:254-245-9175
Practice Address - Fax:254-213-7771
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704330417367500000X
TXAP122766367500000X
TN9551367500000X
KY42293367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00632178OtherRAILROAD MEDICARE PIN
TN3600032Medicaid
KY7100056400Medicaid
KY000000514332OtherBLUE CROSS/BLUE SHIELD
TNP00479787OtherRAILROAD MEDICARE PIN
TN4155027OtherBLUE CROSS/BLUE SHIELD
KY7100056400Medicaid
TN4155027OtherBLUE CROSS/BLUE SHIELD