Provider Demographics
NPI:1841559267
Name:OWEN, JEFFERY SCOTT (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:SCOTT
Last Name:OWEN
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 1:9521 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-0900
Mailing Address - Country:US
Mailing Address - Phone:870-692-0357
Mailing Address - Fax:
Practice Address - Street 1:525 WESTERN AVENUE STE 201
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4980
Practice Address - Country:US
Practice Address - Phone:501-327-6665
Practice Address - Fax:501-730-0289
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC02916367500000X
ARR78203163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse