Individual
AMBER LOUANN BOLYARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1115 S WALDRON RD STE 107, FORT SMITH, AR 72903-2584
(479) 785-2555
Mailing address
7703 FLOYD CURL DR, SAN ANTONIO, TX 78229-3901
(210) 358-4000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R71508
AR
367500000X
Certified Registered Nurse Anesthetist
AP126085
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
C02707
AR
367500000X
Certified Registered Nurse Anesthetist
CTP000070
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171992001
—
AR
05
—
340737101
—
TX
01
—
P00628610
RR MEDICARE GROUP CG8899
AR
01
—
P00872567
RAILROAD MEDICARE
AR
Enumeration date
06/24/2008
Last updated
01/16/2018
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