=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275749228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NURSE ANESTHESIA PROVIDERS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2007
-----------------------------------------------------
Last Update Date | 10/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3353 N GLOSTER ST
-----------------------------------------------------
City | TUPELO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38804-9735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-407-0334
-----------------------------------------------------
Fax | 662-407-0335
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 85
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39043-0085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-260-2350
-----------------------------------------------------
Fax | 601-706-4175
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBIN W SEALE
-----------------------------------------------------
Credential | CRNA
-----------------------------------------------------
Telephone | 601-260-2350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | R686891
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------