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General NPI Number Information
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NPI Number | 1922530807
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Entity Type | Individual
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Provider Name | CHRISTOPHER RYAN KENNEDY CRNA
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Gender | Male
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 3215 N NORTHHILLS BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4424
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Country | US
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Telephone | 479-263-8669
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Fax |
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Provider Business Mailing Address
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Address Line | 21 TURTLE CREEK DR
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City | TEXARKANA
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State | AR
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Zip | 71854-8373
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Country | US
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Telephone | 903-276-8324
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | C003186
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License Number State | AR
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