Healthcare Provider Details

I. General information

NPI: 1255659546
Provider Name (Legal Business Name): RICHARD THOMAS SHEPPARD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 STADIUM BLVD
JONESBORO AR
72401-7415
US

IV. Provider business mailing address

2024 ARKANSAS VALLEY DR SUITE 202
LITTLE ROCK AR
72212-4166
US

V. Phone/Fax

Practice location:
  • Phone: 870-972-7413
  • Fax:
Mailing address:
  • Phone: 501-227-0700
  • Fax: 501-227-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCTP000133
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: