Provider Demographics
NPI:1194113076
Name:MCDANIEL, JAMES A (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11880
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1880
Mailing Address - Country:US
Mailing Address - Phone:479-452-1581
Mailing Address - Fax:479-452-2148
Practice Address - Street 1:1115 S WALDRON RD
Practice Address - Street 2:107
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2551
Practice Address - Country:US
Practice Address - Phone:479-452-1581
Practice Address - Fax:479-452-2148
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC003064367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARC003064OtherCRNA LICENSE