MEDICARE: CHRISTOPHER JARVIS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	A004861	AR
2	363LG0600X	Gerontology Nurse Practitioner	A004861	AR

General Provider Information

NPI Number	:	1124575147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER JARVIS APRN

Provider Business Mailing Address
First Line	:	1 MERCY LN STE 304
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6440
Country	:	US
Telephone Number	:	501-321-4772
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MERCY LN STE 304
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6440
Country	:	US
Telephone Number	:	501-321-4772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	09/07/2016

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