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NPI Code Detail

MEDICARE: MR. CHRISTOPHER L SURRATT APRN

MEDICARE: MR. CHRISTOPHER L SURRATT APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerA01707AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
25X469OTHERARBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114096963
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHRISTOPHER L SURRATT APRN
Provider Business Mailing Address
First Line : 1100 MEDICAL DR
Second Line : SUITE D
City : BLYTHEVILLE
State : AR
Zip : 72315-1425
Country : US
Telephone Number : 870-838-7385
Fax Number : 870-762-4781
Provider Business Practice Location Address
First Line : 1100 MEDICAL DR
Second Line : SUITE D
City : BLYTHEVILLE
State : AR
Zip : 72315-1425
Country : US
Telephone Number : 870-838-7385
Fax Number : 870-762-4781
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 10/21/2016

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