Individual
MR. JEROLD BENJAMIN CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
311 MORROW ST N, MENA, AR 71953-2516
(479) 394-6100
Mailing address
PO BOX 20343, HOT SPRINGS, AR 71903-0343
(501) 520-5204
(501) 520-5185
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C00491
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113755001
—
AR
01
—
430080341
RR MEDICARE GROUP CK6327
—
01
—
59312
AR BCBS
AR
Enumeration date
09/23/2005
Last updated
06/10/2010
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