Individual
SCOTT SHEPHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3215 N NORTHHILLS BLVD, FAYETTEVILLE, AR 72703-4424
(918) 664-9892
(918) 664-2521
Mailing address
4500 S GARNETT RD, STE 300, TULSA, OK 74146-5229
(918) 664-9892
(918) 664-2521
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C01510
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157034001
—
AR
05
—
200051950A
—
OK
01
—
771003601
ARKANSAS BREASTCARE
AR
Enumeration date
06/14/2006
Last updated
02/10/2012
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