Healthcare Provider Details

I. General information

NPI: 1336396415
Provider Name (Legal Business Name): RONALD JOE BYRD FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 S MAIN ST
SNOWFLAKE AZ
85937-5228
US

IV. Provider business mailing address

1300 S MAIN ST STE A
SNOWFLAKE AZ
85937-5662
US

V. Phone/Fax

Practice location:
  • Phone: 928-536-7519
  • Fax: 928-536-7305
Mailing address:
  • Phone: 928-536-7519
  • Fax: 928-536-7305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3061
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: