Provider Demographics
NPI:1164496469
Name:WRIGHT, JOE (CRNA)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:WRIGHT
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 1:2729 S HIGHWAY 65 82
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-6136
Mailing Address - Country:US
Mailing Address - Phone:870-265-5351
Mailing Address - Fax:870-265-9306
Practice Address - Street 1:2729 S HIGHWAY 65 82
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-6136
Practice Address - Country:US
Practice Address - Phone:870-265-5351
Practice Address - Fax:870-265-9306
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR32806367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR115534701Medicaid
AR59537OtherBLUE CROSS OF AR
AR59537OtherBLUE CROSS OF AR
AR115534701Medicaid