Individual
RUSSELL T BEAVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
24 GLASGOW CT, LITTLE ROCK, AR 72211-2170
(870) 489-1592
Mailing address
24 GLASGOW CT, LITTLE ROCK, AR 72211-2170
(870) 489-1592
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C00338
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125085701
—
AR
01
—
430014101
RRMCR/PGBA
—
01
—
59622
BCBS
AR
01
—
AR6003788
TRICARE/HUMANA
—
Enumeration date
06/16/2005
Last updated
04/29/2016
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