Provider Demographics
NPI:1295962504
Name:FORD, DIANA J (CNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:J
Last Name:FORD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 COUNTY ROAD 917
Mailing Address - Street 2:
Mailing Address - City:BROOKLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72417-8873
Mailing Address - Country:US
Mailing Address - Phone:870-253-4349
Mailing Address - Fax:
Practice Address - Street 1:300 CARSON ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3104
Practice Address - Country:US
Practice Address - Phone:870-932-1198
Practice Address - Fax:870-910-7710
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR81466163W00000X
ARA004096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse