Provider Demographics
NPI:1134295645
Name:DAVIS, JAMES BURNS (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BURNS
Last Name:DAVIS
Suffix:
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 381
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-0381
Mailing Address - Country:US
Mailing Address - Phone:870-845-4400
Mailing Address - Fax:840-845-4178
Practice Address - Street 1:800 W LESLIE ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-0381
Practice Address - Country:US
Practice Address - Phone:870-845-4400
Practice Address - Fax:870-845-4178
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC00250367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59382Medicare ID - Type Unspecified
OTH000Medicare UPIN