Individual
MR. DERRICK R EDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2601 GENE GEORGE BLVD, SPRINGDALE, AR 72762-0845
(479) 725-6800
Mailing address
PO BOX 507, LOWELL, AR 72745-0507
(913) 647-4100
(913) 647-4120
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C002970
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720309511
TRICARE SOUTH
AR
05
—
1720309511
—
MO
05
—
198801001
—
AR
05
—
200494180A
—
OK
01
—
5UU07
BCBS ARKANSAS
AR
01
—
P01278937
RAILROAD
AR
Enumeration date
06/16/2010
Last updated
06/18/2021
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