Eddy, Derrick R

Eddy, Derrick R is an individual health care provider with primary practice located at 2601 Gene George Blvd , Springdale AR 72762-0845. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Eddy, Derrick R can be contacted via phone (479) 725-6800.

Contact Information

Primary practice address
2601 Gene George Blvd Springdale AR 72762-0845
Phone: (479) 725-6800
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X C002970 Arkansas

Profile Details

NPI number 1720309511
LBN Legal business name Eddy, Derrick R
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2010
Last updated Jun 18th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720309511 NPPES
Arkansas Other 1720309511 TRICARE SOUTH
Arkansas Other P01278937 TRICARE SOUTH
Arkansas Other 5UU07 TRICARE SOUTH
Arkansas MEDICAID 198801001 TRICARE SOUTH
Arkansas MEDICAID 200494180A TRICARE SOUTH
Arkansas MEDICAID 1720309511 TRICARE SOUTH

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