Provider Demographics
NPI:1184861395
Name:BOBO, PYKE (CRNA)
Entity Type:Individual
Prefix:
First Name:PYKE
Middle Name:
Last Name:BOBO
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 1:311 NORTH MORROW
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-2516
Mailing Address - Country:US
Mailing Address - Phone:479-394-6100
Mailing Address - Fax:479-394-4577
Practice Address - Street 1:1800 MEDICAL CENTER PKWY
Practice Address - Street 2:STE 330
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2567
Practice Address - Country:US
Practice Address - Phone:615-396-4464
Practice Address - Fax:615-396-6748
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC002948367500000X
TNRN135627367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4220774OtherBLUE CROSS BLUE SHIELD
TN3600459Medicaid
TN3600459OtherRAIL ROAD MEDICARE
TN3600459Medicare PIN