Basic Information
| Provider Information | |||||||||
| NPI: | 1164676185 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOSEPH KENT CRNA INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11964 | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729171964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797852555 | ||||||||
| FaxNumber: | 4797853555 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 S 56TH ST | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729033755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797852555 | ||||||||
| FaxNumber: | 4797853555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2008 | ||||||||
| LastUpdateDate: | 12/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | KENT | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4797852555 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | C00348 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 200259460A | 05 | OK | MEDICAID |