Provider Demographics
NPI:1174863799
Name:BRADSHAW DOBBINS, JO BETH (CRNA)
Entity type:Individual
Prefix:MS
First Name:JO
Middle Name:BETH
Last Name:BRADSHAW DOBBINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JO
Other - Middle Name:BETH
Other - Last Name:BRADSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-812-7800
Mailing Address - Fax:501-812-7777
Practice Address - Street 1:1001 TOWSON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4921
Practice Address - Country:US
Practice Address - Phone:479-441-5291
Practice Address - Fax:479-441-4162
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC002953367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered