Rex Dwayne Waggoner, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

26949 Issued in AR

Practice address

609 W Maple Ave
Springdale, AR 72764-5335

Phone

(479) 757-5711

NPI assigned

Nov 30, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rex D Waggoner PA

  • Certified Registered Nurse Anesthetist
  • Springdale, AR
  • NPI 1285859009

  Nurse Anesthetist, Certified Registered

  NPD (past) Authorized official
• Physicians' Surgery Center of Fayetteville, LLC

  • Ambulatory Surgical Clinic/Center
  • Fayetteville, AR
  • NPI 1285622845
  NPD (past)
• Springdale Bentonville Surgery Center LP

  • Ambulatory Surgical Clinic/Center
  • Springdale, AR
  • NPI 1730131731
  NPD (past)

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1790769164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 OVERO CIR",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727622129",
            "telephone_number": "479-756-2252",
            "fax_number": "479-751-6352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 W MAPLE AVE",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727645335",
            "telephone_number": "479-757-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "REX",
        "middle_name": "DWAYNE",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "26949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Voelz, OTR/L
• Nolan Joshua Vondran
• Ronnie Deann Vowell Jr.
• Leigh Anna Wade, LCSW, RPT-S
• Kyle J Wages, PT, DPT
• Richard Waggoner
• Sameer Umakant Wagle, MD
• Raymond Dale Wagoner, M.S., LPC
• Joanna Wakefield, AUD CCC-A
• La'Troy Dante Wakefield, MHPP

• Certified Registered Nurse Anesthetist in Springdale, AR
• Providers in Springdale, AR by specialty
• Certified Registered Nurse Anesthetist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.