Basic Information
| Provider Information | |||||||||
| NPI: | 1841559267 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OWEN | ||||||||
| FirstName: | JEFFERY | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9521 SULPHUR SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | PINE BLUFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716030900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706920357 | ||||||||
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| Practice Location | |||||||||
| Address1: | 525 WESTERN AVENUE STE 201 | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720344980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013276665 | ||||||||
| FaxNumber: | 5017300289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2012 | ||||||||
| LastUpdateDate: | 06/01/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | C02916 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163W00000X | R78203 | AR | N | Nursing Service Providers | Registered Nurse |
No ID Information.