Healthcare Provider Details

I. General information

NPI: 1548233133
Provider Name (Legal Business Name): RAYMOND R (RUSTY) SMITH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAYMOND R (RUSTY) SMITH CRNA

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 AIMEE RD
FERRIDAY LA
71334-9615
US

IV. Provider business mailing address

241 AIMEE RD
FERRIDAY LA
71334-9615
US

V. Phone/Fax

Practice location:
  • Phone: 318-757-6371
  • Fax: 318-757-6371
Mailing address:
  • Phone: 318-757-6371
  • Fax: 318-757-7847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN032208
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR611034
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: