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General NPI Number Information
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NPI Number | 1043251523
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Entity Type | Individual
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Provider Name | JAMES L SHEALY CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 620 N WILLOW ST
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City | HARRISON
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State | AR
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Zip | 72601-2994
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Country | US
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Telephone | 870-424-7070
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Fax | 870-424-6616
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Provider Business Mailing Address
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Address Line | PO BOX 432
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City | MOUNTAIN HOME
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State | AR
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Zip | 72654-0432
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Country | US
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Telephone | 870-424-7070
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Fax | 870-424-6616
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R55533
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License Number State | AR
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