Basic Information
| Provider Information | |||||||||
| NPI: | 1609340827 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANFILL | ||||||||
| FirstName: | ALEX | ||||||||
| MiddleName: | TAYLOR | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 607 N RIVER BEND DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723642676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017346344 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7301 ROGERS AVE | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729034100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797852555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2019 | ||||||||
| LastUpdateDate: | 06/12/2019 | ||||||||
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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 | 120222 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.