Healthcare Provider Details

I. General information

NPI: 1164714192
Provider Name (Legal Business Name): DENTON CARL STOKES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 N OAK AVE
RULEVILLE MS
38771-3227
US

IV. Provider business mailing address

345 LAUGHLIN RD
BOYLE MS
38730-8802
US

V. Phone/Fax

Practice location:
  • Phone: 662-756-1739
  • Fax:
Mailing address:
  • Phone: 601-218-3147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR865081
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: