Healthcare Provider Details

I. General information

NPI: 1952555377
Provider Name (Legal Business Name): THORNTON SCOTT SPRADLING JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 PRIDE LN
CABOT AR
72023-7913
US

IV. Provider business mailing address

4112 PRIDE LN
CABOT AR
72023-7913
US

V. Phone/Fax

Practice location:
  • Phone: 501-680-6894
  • Fax:
Mailing address:
  • Phone: 501-680-6894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC002744
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: