Individual
CRYSTAL GAYLE COULTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1101 THORNRIDGE RD, BENTONVILLE, AR 72713-8321
(731) 803-2022
Mailing address
1101 THORNRIDGE RD, BENTONVILLE, AR 72713-8321
(731) 803-2022
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R079247
AR
207L00000X
Anesthesiology Physician
C003164
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
C003164
AR
Other
Enumeration date
07/11/2016
Last updated
07/30/2023
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