Provider Demographics
NPI:1861544173
Name:JURGENSMEYER, CHRIS (CRNA)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:JURGENSMEYER
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 1:310 GRAND OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-8685
Mailing Address - Country:US
Mailing Address - Phone:931-216-6205
Mailing Address - Fax:
Practice Address - Street 1:302 W 14TH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3751
Practice Address - Country:US
Practice Address - Phone:931-216-6205
Practice Address - Fax:270-725-4569
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL006495367500000X
IN28214783A367500000X
KY3005108367500000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNVAD000Medicare UPIN