Healthcare Provider Details

I. General information

NPI: 1548255441
Provider Name (Legal Business Name): DIANNA L OWEN MSN, RN, ARNP, FNP-B
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 03/07/2023
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 THIRD ST
HORSESHOE BEND AR
72512-3736
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 870-670-4861
  • Fax:
Mailing address:
  • Phone: 870-347-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2011005104
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberR69636
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: