Provider Demographics
NPI:1952520132
Name:IVY, CHRIS (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:IVY
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 22390
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-2390
Mailing Address - Country:US
Mailing Address - Phone:877-649-7812
Mailing Address - Fax:918-392-2941
Practice Address - Street 1:1910 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7752
Practice Address - Country:US
Practice Address - Phone:501-321-1000
Practice Address - Fax:870-722-2421
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARCTP-000039367500000X
ARC02660367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00440980OtherRR MEDICARE GROUP CK6327
AR5A372OtherBCBS AR
AR165279001Medicaid
AR5A372Medicare PIN
AR165279001Medicaid