Provider Demographics
NPI:1679061048
Name:EASTERLING, BOBBY JOE JR (CRNA)
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:JOE
Last Name:EASTERLING
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:BJ
Other - Middle Name:
Other - Last Name:EASTERLING
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22390
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-2390
Mailing Address - Country:US
Mailing Address - Phone:855-592-5265
Mailing Address - Fax:855-759-1165
Practice Address - Street 1:1910 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901
Practice Address - Country:US
Practice Address - Phone:501-321-1000
Practice Address - Fax:501-620-2336
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC003255367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered