Provider Demographics
NPI:1205809514
Name:PUCKETT, JUNE L PRATHER (CRNA)
Entity type:Individual
Prefix:MS
First Name:JUNE
Middle Name:L PRATHER
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:JUNE
Other - Middle Name:P
Other - Last Name:PUCKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:1500 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301-2615
Mailing Address - Country:US
Mailing Address - Phone:775-289-3467
Mailing Address - Fax:775-289-8244
Practice Address - Street 1:1500 AVENUE H
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-2615
Practice Address - Country:US
Practice Address - Phone:775-289-3467
Practice Address - Fax:775-289-8244
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVRN11060163W00000X
NVNVCRNA000029367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV34522Medicare ID - Type UnspecifiedMEDICARE PART B