Individual
JIM GLENN DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
502 GREENING ST, SUITE 3C, CAMDEN, AR 71701-3491
(870) 837-4065
Mailing address
502 GREENING STREET, SUITE 3C, CAMDEN, AR 71701
(870) 837-4065
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
C00332
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
C000332
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135850002
—
AR
Enumeration date
04/13/2007
Last updated
03/31/2021
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