Provider Demographics
NPI:1114096963
Name:SURRATT, CHRISTOPHER L (APRN)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:L
Last Name:SURRATT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 MEDICAL DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-1425
Mailing Address - Country:US
Mailing Address - Phone:870-838-7385
Mailing Address - Fax:870-762-4781
Practice Address - Street 1:1100 MEDICAL DR
Practice Address - Street 2:SUITE D
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-1425
Practice Address - Country:US
Practice Address - Phone:870-838-7385
Practice Address - Fax:870-762-4781
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160962758Medicaid
AR5X469OtherBCBS
AR5X469OtherBCBS
AR160962758Medicaid