Individual
CHRIS IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1910 MALVERN AVE, HOT SPRINGS, AR 71901-7752
(501) 321-1000
(870) 722-2421
Mailing address
PO BOX 22390, HOT SPRINGS, AR 71903-2390
(877) 649-7812
(918) 392-2941
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C02660
AR
367500000X
Certified Registered Nurse Anesthetist
CTP-000039
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165279001
—
AR
01
—
5A372
BCBS AR
AR
01
—
P00440980
RR MEDICARE GROUP CK6327
—
Enumeration date
04/25/2007
Last updated
10/23/2014
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