Healthcare Provider Details

I. General information

NPI: 1134295645
Provider Name (Legal Business Name): JAMES BURNS DAVIS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W LESLIE ST
NASHVILLE AR
71852-0381
US

IV. Provider business mailing address

PO BOX 381
NASHVILLE AR
71852-0381
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-4400
  • Fax: 870-845-4178
Mailing address:
  • Phone: 870-845-4400
  • Fax: 840-845-4178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC00250
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: