Provider Demographics
NPI:1548255441
Name:OWEN, DIANNA L (MSN, RN, ARNP, FNP-B)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:L
Last Name:OWEN
Suffix:
Gender:F
Credentials:MSN, RN, ARNP, FNP-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:
Practice Address - Street 1:805 THIRD ST
Practice Address - Street 2:
Practice Address - City:HORSESHOE BEND
Practice Address - State:AR
Practice Address - Zip Code:72512-3736
Practice Address - Country:US
Practice Address - Phone:870-670-4861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR69636164W00000X
MO2011005104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1548255441Medicaid
AR710561580OtherTAX ID
P00036132OtherRAILROAD MEDICARE
AR5X425OtherBLUE CROSS
MO429138605Medicaid
ARR69636OtherLICENSE #
AR150127758Medicaid
5X425OtherARBCBS
5X425OtherARBCBS
P00036132OtherRAILROAD MEDICARE
MO1548255441Medicaid