Provider Demographics
NPI:1972961068
Name:BAYARD, ALINE (CNP)
Entity Type:Individual
Prefix:
First Name:ALINE
Middle Name:
Last Name:BAYARD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6131 S NORCROSS TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-5536
Mailing Address - Country:US
Mailing Address - Phone:678-205-1959
Mailing Address - Fax:770-552-7100
Practice Address - Street 1:80 B VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:ACOMA
Practice Address - State:NM
Practice Address - Zip Code:87034
Practice Address - Country:US
Practice Address - Phone:505-552-5300
Practice Address - Fax:505-552-5490
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN141931363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH3451Medicaid
NMH3451Medicaid