Beavers, Russell T

Beavers, Russell T is an individual health care provider with primary practice located at 24 Glasgow Ct , Little Rock AR 72211-2170. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Beavers, Russell T can be contacted via phone (870) 489-1592.

Contact Information

Primary practice address
24 Glasgow Ct Little Rock AR 72211-2170
Phone: (870) 489-1592
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X C00338 Arkansas

Profile Details

NPI number 1700881778
LBN Legal business name Beavers, Russell T
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2005
Last updated Apr 29th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700881778 NPPES
Arkansas Other 59622 BCBS
Arkansas Other 430014101 BCBS
Arkansas MEDICAID 125085701 BCBS
Arkansas Other AR6003788 BCBS

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