Healthcare Provider Details

I. General information

NPI: 1407267859
Provider Name (Legal Business Name): MATTHEW BATEMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TOWSON AVE
FORT SMITH AR
72901-4921
US

IV. Provider business mailing address

2508 HIGHWAY 284
WYNNE AR
72396-8478
US

V. Phone/Fax

Practice location:
  • Phone: 479-441-4190
  • Fax:
Mailing address:
  • Phone: 870-318-4879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR82315
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: