Provider Demographics
NPI:1679708804
Name:PRICE, PRISCILLA M (CRNA)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:M
Last Name:PRICE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:M
Other - Last Name:HAMBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2920 N CASCADE AVE
Mailing Address - Street 2:FL 3
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6262
Mailing Address - Country:US
Mailing Address - Phone:636-549-2380
Mailing Address - Fax:314-569-5974
Practice Address - Street 1:7145 PERKINS ROAD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4322
Practice Address - Country:US
Practice Address - Phone:225-765-3111
Practice Address - Fax:225-765-3114
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR78015367500000X
LARN103251367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1819590Medicaid
LA3B487CE14Medicare PIN