Healthcare Provider Details

I. General information

NPI: 1578974465
Provider Name (Legal Business Name): NICHOLAS BRAD BEGLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 WEST MARKHAM SLOT 515 UAMS DEPARTMENT OF ANESTHESIOLOGY
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

15B FERRY BOAT RD
BIGELOW AR
72016-7035
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-6114
  • Fax:
Mailing address:
  • Phone: 501-343-8329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number80598
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC003041
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: