Provider Demographics
NPI:1205801073
Name:MCFATRIDGE, MARK WARREN (CRNA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:WARREN
Last Name:MCFATRIDGE
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 144
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-0144
Mailing Address - Country:US
Mailing Address - Phone:501-279-2426
Mailing Address - Fax:501-279-2501
Practice Address - Street 1:606 W. ARCH AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143
Practice Address - Country:US
Practice Address - Phone:501-279-2426
Practice Address - Fax:501-279-2501
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC01289367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W185Medicare ID - Type Unspecified