Provider Demographics
NPI:1912910290
Name:ADKINS, MARK D (CRNA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:ADKINS
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 1:39 COUNTY ROAD 967
Mailing Address - Street 2:
Mailing Address - City:BROOKLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72417-8799
Mailing Address - Country:US
Mailing Address - Phone:870-972-9594
Mailing Address - Fax:
Practice Address - Street 1:909 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-9201
Practice Address - Country:US
Practice Address - Phone:870-336-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC01477367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X685OtherBCBS
AR5X685Medicare ID - Type Unspecified