Individual
MS. IRMA N JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1601 NEW CASTLE RD, FORREST CITY, AR 72335-2218
(870) 261-0513
(870) 261-0126
Mailing address
6286 BRIARCREST AVE, MEMPHIS, TN 38120-4023
(901) 747-4624
(901) 261-2542
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R015393
AR
164W00000X
Licensed Practical Nurse
P000113
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
C00494
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135871701
—
AR
01
—
1841288040
QUALCHOICE OF ARKANSAS
AR
01
—
59463
ARKANSAS BLUE CROSS BLUE SHIELD
AR
01
—
P00299197
RAILROAD MEDICARE
AR
Enumeration date
10/11/2005
Last updated
10/24/2014
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