Provider Demographics
NPI:1649411455
Name:SCAGGS, KRISTA E (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:E
Last Name:SCAGGS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:E
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:620 N MAIN
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2911
Mailing Address - Country:US
Mailing Address - Phone:870-414-4000
Mailing Address - Fax:870-414-4961
Practice Address - Street 1:620 N MAIN
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2911
Practice Address - Country:US
Practice Address - Phone:870-414-4000
Practice Address - Fax:870-414-4961
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO155401367500000X
ARC002966367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR771164501OtherBREASTCARE
AR179294001Medicaid
AR179294001Medicaid