Healthcare Provider Details

I. General information

NPI: 1629027446
Provider Name (Legal Business Name): PHILLIP J ZAPPA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 HOSPITAL DR
MOUNTAIN HOME AR
72653-2955
US

IV. Provider business mailing address

PO BOX 1269
MOUNTAIN HOME AR
72654-1269
US

V. Phone/Fax

Practice location:
  • Phone: 870-424-1000
  • Fax: 870-424-6616
Mailing address:
  • Phone: 870-424-7070
  • Fax: 870-424-6616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC01180
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: