Healthcare Provider Details

I. General information

NPI: 1306872882
Provider Name (Legal Business Name): KRISTI L KROONA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 JACKSON ST SW
GRAVETTE AR
72736-9121
US

IV. Provider business mailing address

1101 JACKSON ST SW
GRAVETTE AR
72736-9121
US

V. Phone/Fax

Practice location:
  • Phone: 479-787-5291
  • Fax: 479-344-6404
Mailing address:
  • Phone: 479-787-5291
  • Fax: 479-344-6404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0084172
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11688
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC001195
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: