Provider Demographics
NPI:1518744788
Name:LEYBA, EVAN (DNAP-CRNA)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:LEYBA
Suffix:
Gender:M
Credentials:DNAP-CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 BOWMAN RD APT C23
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-2376
Mailing Address - Country:US
Mailing Address - Phone:219-781-5521
Mailing Address - Fax:
Practice Address - Street 1:1910 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7799
Practice Address - Country:US
Practice Address - Phone:219-781-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR217727367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered