Individual
DIANNA L OWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, RN, ARNP, FNP-B
Contact information
Practice address
805 THIRD ST, HORSESHOE BEND, AR 72512-3736
(870) 670-4861
Mailing address
PO BOX 497, AUGUSTA, AR 72006-0497
(870) 347-2534
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
R69636
AR
363LF0000X
Family Nurse Practitioner
Primary
2011005104
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150127758
—
AR
05
—
1548255441
—
MO
05
—
429138605
—
MO
01
—
5X425
BLUE CROSS
AR
01
—
5X425
ARBCBS
—
01
—
710561580
TAX ID
AR
01
—
P00036132
RAILROAD MEDICARE
—
01
—
R69636
LICENSE #
AR
Enumeration date
09/16/2005
Last updated
03/07/2023
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