1548255441 NPI number — DIANNA L OWEN MSN, RN, ARNP, FNP-B

Table of content: DIANNA L OWEN MSN, RN, ARNP, FNP-B (NPI 1548255441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548255441 NPI number — DIANNA L OWEN MSN, RN, ARNP, FNP-B

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OWEN
Provider First Name:
DIANNA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, ARNP, FNP-B
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548255441
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 497
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72006-0497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-347-2534
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 THIRD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HORSESHOE BEND
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72512-3736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-670-4861
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  R69636 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 2011005104 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1548255441 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 710561580 . This is a "TAX ID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: P00036132 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5X425 . This is a "BLUE CROSS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 429138605 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: R69636 . This is a "LICENSE #" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 150127758 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5X425 . This is a "ARBCBS" identifier . This identifiers is of the category "OTHER".




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