MEDICARE: BENJAMIN JEFFREY SPILLYARDS 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	C003271	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	124486	OTHER	AR	NBCRNA

General Provider Information

NPI Number	:	1700343324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN JEFFREY SPILLYARDS CRNA

Provider Business Mailing Address
First Line	:	34617 HEINZE CV
Second Line	:
City	:	PARON
State	:	AR
Zip	:	72122-8042
Country	:	US
Telephone Number	:	501-687-7913
Fax Number	:

Provider Business Practice Location Address
First Line	:	34617 HEINZE CV
Second Line	:
City	:	PARON
State	:	AR
Zip	:	72122-8042
Country	:	US
Telephone Number	:	501-687-7913
Fax Number	:

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

Provider Enumeration Date	:	03/01/2019
Last Update Date	:	10/09/2024

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