Provider Demographics
NPI:1396700464
Name:WHEAT, SCOTT GARRETT SR (CRNA)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:GARRETT
Last Name:WHEAT
Suffix:SR
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 1:520 CLAYTON CT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5710
Mailing Address - Country:US
Mailing Address - Phone:985-326-6480
Mailing Address - Fax:
Practice Address - Street 1:520 CLAYTON CT
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5710
Practice Address - Country:US
Practice Address - Phone:985-326-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA078185163W00000X
LAAP04379367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H014Medicare ID - Type Unspecified