Organization
BLACK RIVER ANESTHESIA, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN LYNN WYATT R.N. (OFFICE MANAGER)
(870) 972-8053
Entity
Organization
Contact information
Practice address
2801 MEDICAL CENTER DR, POCAHONTAS, AR 72455-9436
(870) 972-8053
(870) 972-8053
Mailing address
PO BOX 1288, JONESBORO, AR 72403-1288
(870) 972-8053
(870) 972-8053
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C00474 CRNA
AR
Other
Enumeration date
01/25/2007
Last updated
08/22/2020
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