Provider Demographics
NPI:1619233475
Name:SIMS, JOHN S JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:S
Last Name:SIMS
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 1:251 DAWSON SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5544
Mailing Address - Country:US
Mailing Address - Phone:501-681-9771
Mailing Address - Fax:
Practice Address - Street 1:251 DAWSON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-5544
Practice Address - Country:US
Practice Address - Phone:501-681-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARCO2920367500000X
IL209.009611367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered