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General NPI Number Information
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NPI Number | 1750771564
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Entity Type | Individual
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Provider Name | JOSHUA MATTHEW BALES CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/01/2015
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 801 COTTAGE DR
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5400
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Country | US
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Telephone | 501-686-8118
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Fax | 501-526-7217
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Provider Business Mailing Address
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Address Line | 4301 W MARKHAM ST # 783
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7101
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Country | US
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Telephone | 501-686-8000
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Fax | 501-526-5148
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN0000163536
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License Number State | TN
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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 | 19957
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 228292
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License Number State | AR
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