Healthcare Provider Details

I. General information

NPI: 1306639083
Provider Name (Legal Business Name): KOLTON LAYNE HOOKS DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 40TH AVE
PINE BLUFF AR
71603-6301
US

IV. Provider business mailing address

PO BOX 83
STAR CITY AR
71667-0083
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-7100
  • Fax:
Mailing address:
  • Phone: 870-718-2594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number124590
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: