Provider Demographics
NPI:1134177280
Name:SWOGGER, KENT E (CRNA)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:E
Last Name:SWOGGER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 557
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-0557
Mailing Address - Country:US
Mailing Address - Phone:870-423-4949
Mailing Address - Fax:870-423-4754
Practice Address - Street 1:207 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-3921
Practice Address - Country:US
Practice Address - Phone:870-423-4949
Practice Address - Fax:870-423-4754
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC00517367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59253OtherBCBS
MO912707007Medicaid
AR113181001Medicaid
430022115OtherRAILROAD MEDICARE
AR59253OtherBCBS
430022115OtherRAILROAD MEDICARE