Healthcare Provider Details

I. General information

NPI: 1184861395
Provider Name (Legal Business Name): PYKE BOBO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MEDICAL CENTER PKWY STE 330
MURFREESBORO TN
37129-2567
US

IV. Provider business mailing address

311 NORTH MORROW
MENA AR
71953-2516
US

V. Phone/Fax

Practice location:
  • Phone: 615-396-4464
  • Fax: 615-396-6748
Mailing address:
  • Phone: 479-394-6100
  • Fax: 479-394-4577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC002948
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number80404
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: