Healthcare Provider Details

I. General information

NPI: 1285875443
Provider Name (Legal Business Name): DANIEL HEATH RAGSDALE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 E 81ST ST
TULSA OK
74137-2125
US

IV. Provider business mailing address

1027 E MAIN ST
MORRISTOWN TN
37814-6632
US

V. Phone/Fax

Practice location:
  • Phone: 918-401-1002
  • Fax:
Mailing address:
  • Phone: 423-581-5987
  • Fax: 423-581-0984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number14006
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0082952
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: