Provider Demographics
NPI:1871153122
Name:BLEDSOE, RUSTY HUGH (CRNA)
Entity type:Individual
Prefix:
First Name:RUSTY
Middle Name:HUGH
Last Name:BLEDSOE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 482 BOX 2778
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96362-0028
Mailing Address - Country:US
Mailing Address - Phone:903-331-2708
Mailing Address - Fax:
Practice Address - Street 1:CHATAN, NAKAGAMI DISTRICT
Practice Address - Street 2:
Practice Address - City:OKINAWA
Practice Address - State:OKINAWA
Practice Address - Zip Code:9040103
Practice Address - Country:JP
Practice Address - Phone:903-331-2708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX780156367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty