MEDICARE: KRISTOPHER A BAILEY CRNA

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
1	367500000X	Certified Registered Nurse Anesthetist	C01305	AR
2	163W00000X	Registered Nurse	R52454	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5A131	OTHER	AR	BC/BS OF AR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689750473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTOPHER A BAILEY CRNA

Provider Business Mailing Address
First Line	:	PO BOX 10911
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72917-0911
Country	:	US
Telephone Number	:	479-926-9089
Fax Number	:

Provider Business Practice Location Address
First Line	:	8200 MILE TREE DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-4373
Country	:	US
Telephone Number	:	479-926-9089
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	01/12/2017

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Directions to “ KRISTOPHER A BAILEY CRNA” Practice Location

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