Provider Demographics
NPI:1508621798
Name:MYERS, EDWARD GEORGE III (CRNA)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:GEORGE
Last Name:MYERS
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10711 RYE HILL RD S
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-8441
Mailing Address - Country:US
Mailing Address - Phone:479-221-1267
Mailing Address - Fax:
Practice Address - Street 1:5721 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3753
Practice Address - Country:US
Practice Address - Phone:913-498-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS43-558165-081367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered