Provider Demographics
NPI:1205894227
Name:FLOWERS, DAVID J (CRNA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:FLOWERS
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 1:5123 MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-3201
Mailing Address - Country:US
Mailing Address - Phone:228-363-9165
Mailing Address - Fax:
Practice Address - Street 1:5123 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-3201
Practice Address - Country:US
Practice Address - Phone:228-363-9165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN050736367500000X
AL1-063196367500000X
AK286367500000X
CA3247367500000X
CO95899367500000X
FLARNP9242030367500000X
IA112318367500000X
LAAP04019367500000X
MSR740159367500000X
MO119430367500000X
NMR54258367500000X
VA0024166519367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00110127Medicaid
LA0059789Medicaid
SCGAN605Medicaid
LA0059789Medicaid