Provider Demographics
NPI:1124016415
Name:HUMBLE, JAMES R JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:HUMBLE
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22390
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-2390
Mailing Address - Country:US
Mailing Address - Phone:855-592-5265
Mailing Address - Fax:855-759-1165
Practice Address - Street 1:1910 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901
Practice Address - Country:US
Practice Address - Phone:501-321-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA810403367500000X
ARC01434367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X535OtherBCBS
AR152162701Medicaid
P00373012OtherRR MEDICARE GROUP CK6327
AR5X535C752Medicare PIN
AR5X535OtherBCBS
AR523975YQ7WMedicare PIN