Healthcare Provider Details

I. General information

NPI: 1497394803
Provider Name (Legal Business Name): JAMES DEVAN DEARMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 HARDY ST
HATTIESBURG MS
39402-1308
US

IV. Provider business mailing address

3340 PLAYERS CLUB PKWY STE 350
MEMPHIS TN
38125-8949
US

V. Phone/Fax

Practice location:
  • Phone: 601-268-8000
  • Fax: 901-844-1592
Mailing address:
  • Phone: 901-844-1590
  • Fax: 901-844-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number901605
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: