Healthcare Provider Details

I. General information

NPI: 1164557351
Provider Name (Legal Business Name): CONNIE F. BRAY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 N MAIN ST
SALEM AR
72576
US

IV. Provider business mailing address

507 N MAIN ST
SALEM AR
72576
US

V. Phone/Fax

Practice location:
  • Phone: 870-895-2541
  • Fax: 870-895-2957
Mailing address:
  • Phone: 870-895-2541
  • Fax: 870-895-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA369
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: