NPIMap

Organization Active NPI

Black River Anesthesia, PLC

  • Certified Registered Nurse Anesthetist
  • Pocahontas, AR
National Provider Identifier
1124174271
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
C00474 CRNA Issued in AR
Legal business name
BLACK RIVER ANESTHESIA, PLC
Practice address
2801 Medical Center Dr
Pocahontas, AR 72455-9436
Phone
(870) 972-8053
Fax
(870) 972-8053
NPI assigned
Jan 25, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan Lynn Wyatt, R.N.
Title
Office Manager
Phone
(870) 972-8053

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X C00474 CRNA AR Primary

Addresses

Primary practice location

2801 Medical Center Dr
Pocahontas, AR 72455-9436

Mailing address

PO Box 1288
Jonesboro, AR 72403-1288
Phone (870) 972-8053

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124174271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1288",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724031288",
            "telephone_number": "870-972-8053",
            "fax_number": "870-972-8053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 MEDICAL CENTER DR",
            "city": "POCAHONTAS",
            "state": "AR",
            "postal_code": "724559436",
            "telephone_number": "870-972-8053",
            "fax_number": "870-972-8053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER ANESTHESIA, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "870-972-8053",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "C00474 CRNA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocahontas, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.