Healthcare Provider Details

I. General information

NPI: 1396700464
Provider Name (Legal Business Name): SCOTT GARRETT WHEAT SR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 CLAYTON CT
SLIDELL LA
70461-5710
US

IV. Provider business mailing address

520 CLAYTON CT
SLIDELL LA
70461-5710
US

V. Phone/Fax

Practice location:
  • Phone: 985-326-6480
  • Fax:
Mailing address:
  • Phone: 985-326-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number078185
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP04379
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: