Provider Demographics
NPI:1245585405
Name:HARRELL, PATRICK C (CRNA)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:C
Last Name:HARRELL
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 1:4300 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9567
Mailing Address - Country:US
Mailing Address - Phone:870-243-2938
Mailing Address - Fax:
Practice Address - Street 1:1900 EXETER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2954
Practice Address - Country:US
Practice Address - Phone:901-818-2183
Practice Address - Fax:901-682-9522
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR81788163W00000X
TN16912367500000X
ARC002934367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR193905001Medicaid
TN1245585405OtherCHAMPUS/TRICARE
TN4331670OtherBCBST
MS05582309Medicaid
TN1529774Medicaid
TN1245585405OtherCHAMPUS/TRICARE