Provider Demographics
NPI:1225261282
Name:BOYD, DIANE C (APN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:BOYD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 RIKE DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-3937
Mailing Address - Country:US
Mailing Address - Phone:870-534-1834
Mailing Address - Fax:870-534-5798
Practice Address - Street 1:2500 RIKE DR
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-3937
Practice Address - Country:US
Practice Address - Phone:870-534-1834
Practice Address - Fax:870-534-5798
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03270363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180855758Medicaid
AR5V3456979Medicare PIN