Provider Demographics
NPI:1033402250
Name:CAVITT, JENNIFER SUE (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:CAVITT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SUE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:318 NORCROSS DR
Mailing Address - Street 2:
Mailing Address - City:TYRONZA
Mailing Address - State:AR
Mailing Address - Zip Code:72386-3986
Mailing Address - Country:US
Mailing Address - Phone:870-974-3161
Mailing Address - Fax:
Practice Address - Street 1:1601 NEW CASTLE RD
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2218
Practice Address - Country:US
Practice Address - Phone:870-261-0513
Practice Address - Fax:870-261-0535
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR063197163W00000X
ARC002865367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1033402250OtherTRICARE - SOUTH REGION
ARP01391010OtherRAILROAD MEDICARE
AR1033402250OtherBAPTIST HEALTH SERVICES GROUP, INC.
AR1033402250OtherUNITED HEALTHCARE
AR187980001Medicaid
AR5V596OtherARKANSAS BLUE CROSS BLUE SHIELD
AR5V596OtherARKANSAS BLUE CROSS BLUE SHIELD