Provider Demographics
NPI:1124459680
Name:GOODHART, JEFFREY (CRNA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GOODHART
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 FAIR PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1720
Mailing Address - Country:US
Mailing Address - Phone:501-404-8007
Mailing Address - Fax:501-904-3620
Practice Address - Street 1:6119 MIDTOWN AVE STE 101
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5316
Practice Address - Country:US
Practice Address - Phone:501-404-8007
Practice Address - Fax:501-904-3620
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR088752163W00000X
AR121830367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty