Provider Demographics
NPI:1053605758
Name:ALLAIN, JEFFREY PAUL (CRNA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PAUL
Last Name:ALLAIN
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:PO BOX 122431
Mailing Address - Street 2:DEPT 2431
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2431
Mailing Address - Country:US
Mailing Address - Phone:337-480-8900
Mailing Address - Fax:337-480-8901
Practice Address - Street 1:2750 ASTER ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8824
Practice Address - Country:US
Practice Address - Phone:337-480-8900
Practice Address - Fax:337-480-8901
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN117173163W00000X
LAAP06561367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2164821Medicaid