Provider Demographics
NPI:1679569750
Name:AGEE, JOHN SCOTT (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SCOTT
Last Name:AGEE
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 MORROW ST N
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:479-394-5477
Practice Address - Street 1:311 MORROW ST N
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-2516
Practice Address - Country:US
Practice Address - Phone:479-394-6100
Practice Address - Fax:479-394-5477
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC01091367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T923Medicare ID - Type Unspecified