Healthcare Provider Details

I. General information

NPI: 1083163364
Provider Name (Legal Business Name): MICHELLE LEPPERT CRNA, MSA, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N MAIN ST
HARRISON AR
72601-2911
US

IV. Provider business mailing address

173 ROCK FARM LN
PEEL AR
72668-8886
US

V. Phone/Fax

Practice location:
  • Phone: 870-414-4000
  • Fax:
Mailing address:
  • Phone: 939-308-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number226628
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number226628
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: