Provider Demographics
NPI:1700343324
Name:SPILLYARDS, BENJAMIN JEFFREY (CRNA)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JEFFREY
Last Name:SPILLYARDS
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 1:34617 HEINZE CV
Mailing Address - Street 2:
Mailing Address - City:PARON
Mailing Address - State:AR
Mailing Address - Zip Code:72122-8042
Mailing Address - Country:US
Mailing Address - Phone:501-687-7913
Mailing Address - Fax:
Practice Address - Street 1:34617 HEINZE CV
Practice Address - Street 2:
Practice Address - City:PARON
Practice Address - State:AR
Practice Address - Zip Code:72122-8042
Practice Address - Country:US
Practice Address - Phone:501-687-7913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC003271367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124486OtherNBCRNA