Individual
THERESA B HALLIBURTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
11115 SO WALDRON RD, 107, FORT SMITH, AR 72903-2584
(479) 452-1581
(479) 452-2148
Mailing address
PO BOX 11880, FORT SMITH, AR 72917-1880
(479) 452-1581
(479) 452-2149
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C01018 CRNA
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136416701
—
AR
Enumeration date
12/01/2006
Last updated
06/24/2014
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