Provider Demographics
NPI:1467613109
Name:BOLYARD, AMBER LOUANN (CRNA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LOUANN
Last Name:BOLYARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LOUANN
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-358-4000
Mailing Address - Fax:
Practice Address - Street 1:1115 S WALDRON RD STE 107
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2584
Practice Address - Country:US
Practice Address - Phone:479-785-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR71508163W00000X
TXAP126085367500000X
ARCTP000070367500000X
ARC02707367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00628610OtherRR MEDICARE GROUP CG8899
AR171992001Medicaid
TX340737101Medicaid
ARP00872567OtherRAILROAD MEDICARE
TX362988YK00Medicare PIN
TX340737101Medicaid
AR5A9806884Medicare PIN
AR5A980Medicare PIN