Healthcare Provider Details

I. General information

NPI: 1265364871
Provider Name (Legal Business Name): RONALD ANDREW CRUPPER CP-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 SE 28TH ST STE 3
BENTONVILLE AR
72712-3883
US

IV. Provider business mailing address

4 CRESSWELL DR
BELLA VISTA AR
72714-5200
US

V. Phone/Fax

Practice location:
  • Phone: 479-366-3574
  • Fax: 479-307-8560
Mailing address:
  • Phone: 479-366-3574
  • Fax: 479-307-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146E00000X
TaxonomyCommunity Paramedic
License Number23051
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: