Provider Demographics
NPI:1093762569
Name:MYHAN, GARRET (CRNA)
Entity Type:Individual
Prefix:
First Name:GARRET
Middle Name:
Last Name:MYHAN
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:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-0583
Mailing Address - Country:US
Mailing Address - Phone:479-751-3722
Mailing Address - Fax:479-751-1099
Practice Address - Street 1:601 W MAPLE AVE STE 503
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5376
Practice Address - Country:US
Practice Address - Phone:479-751-3722
Practice Address - Fax:479-751-1099
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC01576 CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200740450AMedicaid
MO910053985Medicaid
ARP02314757OtherRAILROAD
AR5Y545OtherBLUE CROSS BLUE SHIELD
ARP00273455OtherRR MEDICARE GRP# CD7786
AR159362001Medicaid