Healthcare Provider Details

I. General information

NPI: 1689750473
Provider Name (Legal Business Name): KRISTOPHER A BAILEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 MILE TREE DR
FORT SMITH AR
72903-4373
US

IV. Provider business mailing address

PO BOX 10911
FORT SMITH AR
72917-0911
US

V. Phone/Fax

Practice location:
  • Phone: 479-926-9089
  • Fax:
Mailing address:
  • Phone: 479-926-9089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC01305
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR52454
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: