Provider Demographics
NPI:1164676185
Name:JOSEPH KENT CRNA INCORPORATED
Entity Type:Organization
Organization Name:JOSEPH KENT CRNA INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:479-785-2555
Mailing Address - Street 1:PO BOX 11964
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1964
Mailing Address - Country:US
Mailing Address - Phone:479-785-2555
Mailing Address - Fax:479-785-3555
Practice Address - Street 1:2301 S 56TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3755
Practice Address - Country:US
Practice Address - Phone:479-785-2555
Practice Address - Fax:479-785-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC00348367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200259460AMedicaid