Healthcare Provider Details

I. General information

NPI: 1669456968
Provider Name (Legal Business Name): PAUL ARP CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 N ROAD ST
ELIZABETH CITY NC
27909-3473
US

IV. Provider business mailing address

181 MARINERS WAY
MOYOCK NC
27958-9049
US

V. Phone/Fax

Practice location:
  • Phone: 252-267-6077
  • Fax:
Mailing address:
  • Phone: 252-267-6077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number003701
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: