Basic Information
| Provider Information | |||||||||
| NPI: | 1154907731 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANNETT | ||||||||
| FirstName: | JOSH | ||||||||
| MiddleName: | TAYLOR | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4716 S 78TH AVE | ||||||||
| Address2: | |||||||||
| City: | RALSTON | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681272824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043279954 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6819 PLUM CREEK DR | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791241602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063546100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2021 | ||||||||
| LastUpdateDate: | 03/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 922634 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 01 | TX | PENDING | OTHER |