Provider Demographics
NPI:1235953969
Name:CRUSE, JAMIE D (RN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:D
Last Name:CRUSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:D
Other - Last Name:GOOCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:4722 WHITE DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-8207
Mailing Address - Country:US
Mailing Address - Phone:870-793-1483
Mailing Address - Fax:866-924-9268
Practice Address - Street 1:2236 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7417
Practice Address - Country:US
Practice Address - Phone:870-847-2500
Practice Address - Fax:866-924-9268
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR071043163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health