Individual
CASEY L HUMPHRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4800 E JOHNSON AVE, JONESBORO, AR 72405-8413
(662) 377-4394
(662) 377-7045
Mailing address
1009 LAKE CREST DR, JONESBORO, AR 72404-9564
(662) 255-4512
(870) 933-7161
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
A810167
MS
367500000X
Certified Registered Nurse Anesthetist
Primary
C001250
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009936767
MEDICAID
AL
05
—
01159742
—
MS
Enumeration date
07/14/2006
Last updated
09/08/2022
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