Individual
JIMMY REX STOCKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1801 W 40TH AVE STE 2B, PINE BLUFF, AR 71603-6957
(870) 535-7457
(870) 535-2522
Mailing address
PO BOX 1272, PINE BLUFF, AR 71613-1272
(870) 535-7457
(870) 535-2522
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C02733
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176401001
—
AR
01
—
5R299
BCBS
AR
01
—
P00698157
RRMCR/PGBA
—
Enumeration date
01/13/2009
Last updated
06/08/2009
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