Provider Demographics
NPI:1992726137
Name:LIVINGSTON DAVIS, LADEAN JOHNSON (CRNA)
Entity type:Individual
Prefix:MRS
First Name:LADEAN
Middle Name:JOHNSON
Last Name:LIVINGSTON DAVIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LADEAN
Other - Middle Name:JOHNSON
Other - Last Name:LIVINGSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:PFS
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-4619
Mailing Address - Fax:601-984-4657
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:PFS
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-4619
Practice Address - Fax:601-984-4657
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866196367500000X
TXAP109903367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0126946Medicaid
MS0126946Medicaid
MS512I430279Medicare PIN