Healthcare Provider Details

I. General information

NPI: 1003830795
Provider Name (Legal Business Name): RHETT SCOTT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 WINTER ST
LUCEDALE MS
39452-6603
US

IV. Provider business mailing address

859 WINTER ST
LUCEDALE MS
39452-6603
US

V. Phone/Fax

Practice location:
  • Phone: 601-766-4286
  • Fax: 601-947-9948
Mailing address:
  • Phone: 601-766-4286
  • Fax: 601-947-9948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR810962
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: