Provider Demographics
NPI:1689750473
Name:BAILEY, KRISTOPHER A (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:A
Last Name:BAILEY
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:PO BOX 10911
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-0911
Mailing Address - Country:US
Mailing Address - Phone:479-926-9089
Mailing Address - Fax:
Practice Address - Street 1:8200 MILE TREE DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4373
Practice Address - Country:US
Practice Address - Phone:479-926-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC01305367500000X
ARR52454163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A131OtherBC/BS OF AR
AR163947001Medicaid
OK200099290AMedicaid
AR5A131Medicare PIN