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General NPI Number Information
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NPI Number | 1295990687
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Entity Type | Individual
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Provider Name | JAMES KENNETH WILSON CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 300 WERNER ST
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City | HOT SPRINGS
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State | AR
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Zip | 71913
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Country | US
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Telephone | 501-622-1930
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Fax | 501-622-1925
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Provider Business Mailing Address
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Address Line | 3810 CENTRAL AVE SUITE H
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City | HOT SPRINGS
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State | AR
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Zip | 71913
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Country | US
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Telephone | 501-525-5840
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Fax | 501-525-5840
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R67079
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CTP000074
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License Number State | AR
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