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NPI Code Detail

MEDICARE: JON C VALENTINE CRNA

MEDICARE: JON C VALENTINE CRNA
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
1367500000XCertified Registered Nurse AnesthetistC01118AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15T930OTHERARBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3430042624OTHERRRMCR/PGBA

General Provider Information

NPI Number : 1306841358
Entity Type Code : Individual
Provider Name (Legal Business Name) : JON C VALENTINE CRNA
Provider Business Mailing Address
First Line : PO BOX 1272
Second Line :
City : PINE BLUFF
State : AR
Zip : 71613-1272
Country : US
Telephone Number : 870-535-7457
Fax Number : 870-535-2522
Provider Business Practice Location Address
First Line : 1801 W 40TH AVE
Second Line : STE 2B
City : PINE BLUFF
State : AR
Zip : 71603-6957
Country : US
Telephone Number : 870-535-7457
Fax Number : 870-535-2522
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 07/28/2008

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Practice Location Address:
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1497750418 — JEFFREY S BRYLES M.D.
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1407851439 — LORI E COLE CRNA
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1356346316 — WALTER P THERIOT CRNA
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1174528186 — FERDINAND K SAMUEL M.D.
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1023013000 — GARY W MANLY CRNA
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Directions to “ JON C VALENTINE CRNA” Practice Location

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