Provider Demographics
NPI:1053325464
Name:ALEXANDER, WADE LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:LYNN
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 CENTRAL AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6921
Mailing Address - Country:US
Mailing Address - Phone:501-525-5840
Mailing Address - Fax:501-525-1762
Practice Address - Street 1:3810 CENTRAL AVE
Practice Address - Street 2:SUITE H
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6921
Practice Address - Country:US
Practice Address - Phone:501-525-5840
Practice Address - Fax:501-525-1762
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR28690163W00000X
ARC00464367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200536220AMedicaid
AR145678701Medicaid
KS146028OtherBCBS
KS200536220AMedicaid
KSP00610361Medicare PIN
AR145678701Medicaid