MEDICARE: GRIFFIN BENTLEY MCCOWAN CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	125772	AR

General Provider Information

NPI Number	:	1134050909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRIFFIN BENTLEY MCCOWAN CRNA

Provider Business Mailing Address
First Line	:	11001 EXECUTIVE CENTER DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4348
Country	:	US
Telephone Number	:	501-202-2093
Fax Number	:	501-202-6316

Provider Business Practice Location Address
First Line	:	9601 BAPTIST HEALTH DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6316
Country	:	US
Telephone Number	:	501-202-2093
Fax Number	:	501-202-6316

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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