Healthcare Provider Details

I. General information

NPI: 1285640185
Provider Name (Legal Business Name): ROBERT KEITH SCOTT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W FOREST AVE
JACKSON TN
38301-3901
US

IV. Provider business mailing address

315 NEBHUT LN
ROSSVILLE TN
38066-1703
US

V. Phone/Fax

Practice location:
  • Phone: 731-927-7072
  • Fax: 731-425-7075
Mailing address:
  • Phone: 713-225-6885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9169
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: