Provider Demographics
NPI:1952671828
Name:USSERY, JEREMY MICHAEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:MICHAEL
Last Name:USSERY
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 1:3715 MONARCH CV
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3374
Mailing Address - Country:US
Mailing Address - Phone:501-472-9034
Mailing Address - Fax:
Practice Address - Street 1:3333 SPRINGHILL DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2922
Practice Address - Country:US
Practice Address - Phone:501-202-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARRNLICENSE#R79237163W00000X
AR#CTP-00182367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse