Provider Demographics
NPI:1861581811
Name:HESTER, SUZANNE M (CRNA)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:HESTER
Suffix:
Gender:F
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 171306
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-1306
Mailing Address - Country:US
Mailing Address - Phone:901-725-5846
Mailing Address - Fax:901-726-4827
Practice Address - Street 1:1755 KIRBY PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-8300
Practice Address - Country:US
Practice Address - Phone:800-809-2106
Practice Address - Fax:334-386-2037
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR70226367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09758529Medicaid
TN4156024OtherBCBS
TNP00421110OtherRR MEDICARE
TN3638424Medicare PIN